Volume 88 - 2025 - Fasc.4 - Case series
Acute pancreatitis in children complicating dyslipidemias: a rare entity in pediatrics
Background: Acute pancreatitis (AP) in children is an
uncommon but increasingly recognized medical condition, with
dyslipidemias, especially severe hypertriglyceridemia, being a
rare etiology. The correlation between primary lipid disorders
and AP is rarely documented in pediatrics.
Objective: To outline three pediatric cases of acute pancreatitiscomplicated
severe hypertriglyceridemia, emphasizing the
challenges in diagnosis, treatment approaches, and outcome.
Cases: Case 1: A 40-day-old infant with consanguineous
parents who was exclusively breastfed showed signs of vomiting
and distension in the abdomen. Laboratory analyses indicated
triglycerides at 15.6 g/L and lipase at six times the upper limit
of normal. Imaging confirmed Balthazar stage C pancreatitis.
Management through fasting and intravenous fluids showed
clinical improvement.
Case 2: A 2-month-old baby had a fever and was vomiting. The
lipid panel showed triglycerides at 25.24 g/L, which is a sign of
familial hypertriglyceridemia (type IV). The lipase level was high
at 498 IU/L, and an ultrasound showed infiltration around the
pancreas. Supportive management improved symptoms, but high
triglyceride levels required changes in diet and the introduction
of fibrates at 2 years of age.
Case 3: A 12-year-old with a history of dyslipidemia
and recurrent pancreatitis was hospitalized for an episode.
Triglycerides rose to 35 g/L, and the lipase level was high. A CT
scan showed Balthazar stage C pancreatitis. Treatment included
fasting, a special diet, fibrates, and omega-3. The patient had five
recurrent episodes over 24 months, despite a brief improvement,
primarily as a result of inadequate dietary adherence.
Conclusion: These cases reflect that, even though severe
hypertriglyceridemia is uncommon in children, it should be
considered when making a differential diagnosis of acute
pancreatitis, especially if lactescent serum is observed. Age-related
dietary limitations and long-term adherence make management
challenging