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258 A Rare Case of Acute Pancreatitis and Reactive Arthritis in Rotavirus Gastroenteritis
  1. Matea Crnković Ćuk,
  2. Barbara Perše,
  3. Mandica Vidović,
  4. Orjena Žaja
  1. Clinical Hospital Centre Sestre milosrdnice

Abstract

Pancreatitis in children is an acute inflammation of the pancreas that manifests itself with abdominal pain localized in the epigastrium and elevated levels of enzymes secreted by the pancreas and is a significant cause of mortality and morbidity. Hyperamylasemia and hyper lipasemia occur relatively frequently in acute gastroenteritis, but pancreatitis itself is relatively rare. Reactive arthritis can also often be associated with acute viral infections although it is extremely rarely described with rotavirus infection.

We present a rare case of pancreatitis and reactive arthritis associated with rotavirus gastroenteritis.

A 5-year-old, 9-month-old girl presented with severe epigastric pain, vomiting, and sub febrile condition that lasted for 24 hours.

Family and personal anamnesis were without peculiarities. At admission, severe pain in the epigastrium, sub febrile and increased peristalsis without other deviations were noted. Leukocytosis (19.3x10 ^ 9, 86% of segmented leukocytes), elevated CRP (19.9 mg/L) and markedly elevated lipase (4025 U/L), serum amylase present in laboratory findings

U/L) and urine (13439 U/L). Rotavirus antigen was isolated in stool by negative other microbiological analysis. No pathology of the hepatobiliary tree, with minimal changes of the pancreas, in terms of hypo echogenicity without effusion was detected by ultrasound. She did not develop cystic lesions.

Upon admission, oral intake was discontinued and parenteral hydration was initiated.

Intensive monitoring shows a favourable trend of rapid decline in amylase and lipase values. After 72 hours, oral administration was started with gradual discontinuation of the intravenous infusion, which was well tolerated. The diet continued with the accelerated introduction of protein and fat without relapse. She was febrile for 3 days with rapid clinical recovery. On the seventh day of the stay, complains of pain and swelling of the dorsum of the left foot with a renewed increase in inflammatory parameters (CRP 27.4 mg/L, SE 52 mm/ 3.6 hp). Through clinical evaluation and ultrasound findings, arthritis was suspected (in the projection of the navicular and cuneiform bone, synovitis and enhanced power – doppler signal). Given the rapid clinical recovery over the next 2 days, without the need for further diagnostic or therapeutic interventions, it was concluded that this was transient reactive arthritis.

Rotavirus is a common cause of severe diarrhoea in children worldwide and it is a significant cause of morbidity in developed countries and mortality in developing countries. Although extremely rare, associated pancreatitis is a serious and potentially fatal extra intestinal complication and further emphasizes the importance of vaccination, especially in infants and young children.

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