Extreme Pregnancy-Induced Hypertriglyceridemia Resulting in Pancreatitis: A Case Report.

Abstract

BACKGROUND Pancreatitis in pregnancy is rare but increasing in frequency, posing potentially serious maternal and fetal consequences. Early recognition of its variable presentations is essential for effective management. CASE REPORT We describe a case of recurrent pancreatitis across multiple pregnancies due to severe pregnancy-induced hypertriglyceridemia. This 33-year-old gravida 7 para 5 woman presented at 37 weeks of gestation with epigastric pain, nausea, and emesis after a high-fat meal. She had a history of hypertriglyceridemic pancreatitis in 4 previous pregnancies but only mildly elevated triglyceride levels outside of pregnancy. On presentation, she was promptly diagnosed with pregnancy-induced hypertriglyceridemic pancreatitis and treated with intravenous insulin, bowel rest, niacin, and gemfibrozil, resulting in clinical improvement by hospital day 5. She underwent labor induction, delivering a healthy female infant vaginally without complications. She was discharged on postpartum day 2 with niacin and gemfibrozil, although she later discontinued them. However, she was found to be doing well at her postpartum visits. CONCLUSIONS This case highlights the recurrent nature of pregnancy-induced hypertriglyceridemic pancreatitis, even in the absence of significant baseline hypertriglyceridemia. This report therefore increases awareness of the potential severity of pregnancy-induced hypertriglyceridemia. It also suggests that providers should consider hypertriglyceridemia in pregnant women with pancreatitis, even in the absence of a significant hypertriglyceridemia history. The timely and accurate diagnosis of pregnancy-induced hypertriglyceridemic pancreatitis should lead to effective, expedited treatment that can improve patient outcomes in this life-threatening condition.