Correspondence

Acute Pancreatitis during Primary HIV-1 Infection

N Engl J Med 1997; 336:1836-1837June 19, 1997

Article

To the Editor:

The most common clinical presentation of primary infection with the human immunodeficiency virus type 1 (HIV-1) is a mononucleosis-like illness.1 Other clinical manifestations include Pneumocystis carinii pneumonia,2 cryptosporidiosis,3 herpes esophagitis,4 and hemorrhagic fever.5 We describe two patients in whom symptomatic primary HIV-1 infection was associated with acute pancreatitis.

A 52-year-old heterosexual man with an HIV-1–positive partner presented with fever (38.5°C), severe abdominal pain, vomiting, and cervical and axillary lymphadenopathy. Three days later a diffuse macular rash appeared. The laboratory data are shown in Table 1Table 1Laboratory Data Obtained at the Onset and Resolution of Acute Pancreatitis in Two Patients with Primary HIV-1 Infection.. Ultrasonography and computed tomography (CT) demonstrated edema of the pancreas, with areas of mild necrosis and heterogeneous peripancreatic tissue.

The pancreatitis resolved after six weeks with appropriate medical therapy, with normalization of pancreatic-enzyme levels and CT findings. Over the same period, seroconversion to positivity for HIV-1 occurred. Antiviral therapy with zidovudine (250 mg two times daily) was initiated two weeks later. Twenty months after seroconversion, the patient is free of symptoms, with 618 CD4 cells per cubic millimeter (27.1 percent of all lymphocytes) and no detectable HIV-1 RNA.

Another patient, a 30-year-old homosexual man, presented with fever (39.5°C), an erythematous macular rash over his trunk, cough, and pharyngitis. The results of laboratory tests are shown in Table 1. There was no abdominal pain, but the CT scan showed an enlarged, edematous pancreas. After almost six weeks, the serum lipase level and abdominal CT scan were normal, and seroconversion for HIV-1 occurred (Table 1). However, the serum amylase and pancreatic isoamylase levels were elevated and remained so after six additional weeks.

Antiviral therapy with zidovudine (250 mg two times daily) was started after 11 months, and treatment with lamivudine (150 mg two times daily) was added 4 months later. Eighteen months after the primary HIV-1 infection, this patient remains free of symptoms with continued antiviral therapy. His CD4 count is 585 cells per cubic millimeter (23.4 percent of all lymphocytes), and his viral load is 3.6 log₁₀ copies per milliliter.

At presentation, serologic tests for Epstein–Barr virus, cytomegalovirus, and herpes simplex virus types 1 and 2 were negative in both patients. Mycobacteriosis and neoplasms were also ruled out. No risk factors for pancreatitis, such as severe hyperlipidemia or excessive intake of alcohol or drugs, were reported either in the patients' history or during follow-up. We conclude that acute pancreatitis should be considered one of the clinical manifestations associated with primary HIV-1 infection. Moreover, it is possible that the acute pancreatitis in these patients could have been due to the HIV-1 infection itself.

Gian Paolo Rizzardi, M.D.
Centre Hospitalier Universitaire Vaudoise, Lausanne, 1005 Switzerland

Giuseppe Tambussi, M.D.
Adriano Lazzarin, M.D.
San Raffaele Scientific Institute, Milan, 20127 Italy

5 References

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Citing Articles (7)

Citing Articles

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   C S Pitchumoni, Nayan M Patel, Prasanna Shah. (2005) Factors Influencing Mortality in Acute Pancreatitis. Journal of Clinical Gastroenterology 39:9, 798-814
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2. 2

   Jeff J. Guo, Raymond Jang, Anthony Louder, Robert J. Cluxton. (2005) Acute Pancreatitis Associated with Different Combination Therapies in Patients Infected with Human Immunodeficiency Virus. Pharmacotherapy 25:8, 1044-1054
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3. 3

   Ryan Tyner, Glenn Turett. (2004) Primary Human Immunodeficiency Virus Infection Presenting as Acute Pancreatitis. Southern Medical Journal 97:4, 393-394
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4. 4

   Greg T Allison, Mathias P Bostrom, Marshall J Glesby. (2003) Osteonecrosis in HIV disease. AIDS 17:1, 1-9
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5. 5

   Ulrich Folsch. (2002) Pancreas 24:4, 412
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6. 6

   Enns, Baillie. (1999) Review article: the treatment of acute biliary pancreatitis. Alimentary Pharmacology and Therapeutics 13:11, 1379-1389
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7. 7

   David M. Aboulafia. (1997) Acute Pancreatitis. Journal of Clinical Gastroenterology 25:4, 640-645
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