Pancreatitis and chronic abdominal pain in a patient with AIDS

A 37-year-old white woman was infected with the human immunodeficiency virus (HIV) through a blood transfusion which she received during a complicated labour in the Ivory Coast. Three years later, due to a decline in the CD4+ cell counts to 200/ml, zidovudine (AZT) and trimethoprim-cotrimoxazole were administered. A few months later, zalcitabine (ddC) was added, due to the appearance of fever, abdominal pain and weight loss, and a further decline in the CD4+ cell counts down to 15/ml. Despite these measures the patient continued to complain of abdominal pain, which was often exacerbated by food intake. Laboratory studies then showed normal serum amylase and liver enzyme levels. Abdominal ultrasonography (US) and gastroscopy were normal. Due to a suspected role of the antiretroviral drug therapy in inducing the abdominal pain, AZT and ddC were discontinued. Three months later, the patient was admitted because of severe abdominal pain, vomiting and a fever of 38.5°C. On examination, marked epigastric tenderness was noted. Investigation results were as follows: amylase 1120 IU/l, hypocalcaemia (1.52 mmol/l), alkaline phosphate 219 IU/l, and gamma-glutamyl transpeptidase 478 IU/l. US and computed tomography (CT) revealed gall bladder wall thickening, with a dilated common bile duct and no evidence of stones. The pancreas was mildly enlarged and oedematous. A diagnosis of pancreatitis was made, a nasogastric tube …