P3915 - Double Trouble: Simultaneous Acute Hepatitis a Infection and Acute Pancreatitis in a Patient With Waldenstrom Macroglobulinemia

Ali K. Yousuf, DO, Chelsi Robertson, MD, Farha Khan, MD
Louisiana State University Health Sciences Center, Lafayette, LA

Introduction: Hepatitis A is an acute infectious disease caused by the hepatitis A virus (HAV). It is a common form of viral hepatitis worldwide, primarily transmitted through the consumption of contaminated food or water or by close contact with an infected individual. Acute HAV infection often presents with nonspecific symptoms, making early recognition crucial for appropriate patient management. This case report aims to describe the clinical presentation, diagnostic approach, and management of a patient with acute HAV infection.

Case Description/Methods: A 70-year-old male presented to the emergency department with a sudden onset of sharp epigastric pain. The patient reported a history of immunodeficiency secondary to waldenstrom macroglobulinemia and lymphoblastic lymphoma. He reported a history of alcohol use and denied any history of intravenous drug use or sexual promiscuity. On physical examination, the patient had acute epigastric tenderness to palpation without guarding, rebound, rigidity, or masses. Laboratory investigations revealed elevated liver function tests, including alanine aminotransferase (ALT) 15 times the upper limit of normal (ULN) and total bilirubin levels of 3 mg/dL. Serological testing demonstrated positive anti-HAV IgM antibodies, detectable HAV RNA by polymerase chain reaction (PCR), and lipase of 223 U/L. Patient was started on supportive care with intravenous fluids and hepatology was consulted for assistance. He was closely monitored with laboratory testing with resolution of his symptoms leading to discharge.

Discussion: The clinical presentation, immunocompromised state, and laboratory findings support the diagnosis of acute hepatitis A infection and subsequent acute pancreatitis in this patient with Waldenstrom macroglobulinemia. The immunosuppressive therapy rendered the patient more susceptible to complications from HAV, such as acute pancreatitis. The management involved supportive care for acute hepatitis A infection, including close monitoring of liver function and hydration. It is crucial to educate the patient about appropriate hand hygiene and preventive measures to limit further transmission of the virus. This case report highlights the challenges in managing acute hepatitis A infection and acute pancreatitis in an immunocompromised patient with Waldenstrom macroglobulinemia. Immunocompromised individuals, especially those undergoing treatment for hematological malignancies, require careful monitoring and prompt intervention in the setting of viral infections.


Disclosures:


Ali K. Yousuf, DO, Chelsi Robertson, MD, Farha Khan, MD. P3915 - Double Trouble: Simultaneous Acute Hepatitis a Infection and Acute Pancreatitis in a Patient With Waldenstrom Macroglobulinemia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.