Acute pancreatitis as a manifestation of HIV seroconversion.

Seroconversion for human immunodeficiency virus (HIV) antibody can be manifested in a variety of illnesses. Most commonly, a mononucleosis-like illness or severe pharyngitis is the presenting complaint. Described is a case of pancreatitis as the presenting illness in the individual's seroconversion for HIV. A 27-year-old healthy male presented with a complaint of nausea, vomiting, and fever for 1 week. The patient reported decreased oral intake and epigastric pain due to the vomiting. Physical exam was remarkable for scleral icterus and right upper quadrant and epigastric tenderness. Initial laboratory data revealed a white blood cell count of 4,000, neutrophil count of 1,600 and platelets of 9,100. Abnormalities in the liver function tests included a total bilirubin of 2.5 mg/dL, AST of 175 IU/L, and LDH of 5717 IU/L. Amylase and lipase were 277 U/L and 1259 U/L, respectively. No gallstones or ductal dilatation were noted on right upper quadrant ultrasound. Although the patient's HIV-1 antibody test was negative 2 months prior to presentation, repeat studies were performed secondary to high-risk sexual behavior and mild neutropenia. The repeat HIV-1 antibody was negative but an HIV-1 P24 antigen was positive. Three weeks later, the HIV-1 antibody was positive and the HIV viral load was greater than 50,000. Acute pancreatitis is common in patients infected with HIV. Medications or lifestyle habits are often the cause of pancreatitis. Only a few cases of acute pancreatitis as the presenting illness during HIV seroconversion can be found in literature review. A mononucleosis-like illness with or without an aseptic meningitis is more commonly the manifestation of HIV seroconversion. We describe a case of HIV seroconversion which presented as acute pancreatitis.

Sarah Jorgensen, DO, and Michael Herman, DO. Naval Hospital Jacksonville, Department of Internal Medicine, Jacksonville, FL.