L-asparaginase-associated pancreatitis

Case contributed by Alejandro Planas Callao
Diagnosis almost certain

Presentation

The patient is being treated with L-asparaginase for acute lymphoblastic leukemia, with severe epigastric pain and elevated amylase.

Patient Data

Age: 20 years
Gender: Female

Diffuse pancreatic gland enlargement. Peripancreatic fluid and fat stranding.

Diffuse free fluid in both anterior pararenal spaces.

Bilateral pleural effusion.

Case Discussion

Our patient was admitted for consolidation treatment for acute lymphoblastic leukemia (ALL). During hospitalization, she suffered epigastric pain with elevated amylase (498 U/L), elevated lipase (2775 U/L), hypoalbuminemia, elevated lactate, and altered coagulation parameters. The clinical picture and the laboratory and CT findings were conclusive for acute pancreatitis.

L-asparagine is part of the consolidation treatment. Acute pancreatitis is among its known adverse effects, typically developing between 3 and 10 days after the last dose. Its clinical presentation and imaging findings do not differ substantially from acute pancreatitis due to other causes. However, its prognosis worsens because of the immunosuppression and comorbidities of all patients undergoing treatment 1.

A diagnosis can be made based on a clinical context, analytical tests, and imaging studies if necessary. Treatment is mainly supportive, focusing on symptomatic control and monitoring for complications 2.

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