Hypertriglyceridemia-Induced Pancreatitis With Rapid Response to Insulin Therapy

Acute pancreatitis (AP) is one of the most common gastrointestinal-related causes of hospitalization in the USA, accounting for more than 200,000 admissions annually. Although mild and moderate cases usually improve within a week, severe AP conditions could lead to life-threatening pancreatic necrosis, multiple-organ dysfunction, and be fatal in some cases. Excessive alcohol use and gallstones are the two leading causes, nonetheless other systemic complication could also lead to AP. Hypertriglyceridemia is an important, yet uncommon, cause/risk factor of AP, especially when associated with heavy alcohol use. Additionally, the level of triglycerides (TGs) was found to be an important factor of determining the method and duration of treatment. Here we present a case of 38-year-old obese and active smoker male with hypertension and alcohol use disorder presented with a chief complaint of 2 weeks of progressive sharp epigastric pain. His medical history was significant of opioid use disorder that is maintained on methadone therapy. Computed tomography (CT) scan of the abdomen and pelvis revealed infiltration of the fat along the pancreatic tail and distal body with focus of decreased enhancement in the very distal pancreatic tail, which could represent a small infarct or phlegmon. In addition, laboratory data was significant of elevated lipase level (> 1,000 mg/dL), which together with the CT result confirmed the diagnosis of AP. Additional laboratory workup revealed extremely high level of TGs of > 2,000 mg/dL. The patient was subsequently transferred to the intensive care unit for management of hypertriglyceridemia. He was started on insulin therapy along with supportive treatment for the management of pancreatitis. Hypertriglyceridemia and pancreatitis rapidly improved over the course of hospitalization period and no additional intervention was needed. He was successfully discharged on fenofibrate.