First Case Report of Pancreatitis in Lyme disease

A 49-year-old man, non-alcoholic forest worker, with no past medical history, consulted to the Emergency Department for fever and persistent abdominal pain for a week. The biological results including, C reactive protein (CRP), lipase, hepatic assessment were normal as well as contrast-enhanced abdominal Computed Tomography (CT). On the day after, the evolution was favorable under symptomatic treatment including nefopam and paracetamol and the patient was discharged from the hospital. One week later, the patient was admitted to the Emergency Department with an identical symptomatology. A posterior quadricipital peeling skin lesion, appeared two weeks earlier according to the patient, was observed (Figure 1a.) A gastroscopy, a colonoscopy, other abdominal CT and biological tests were performed. An inflammation biomarker elevation was observed (CRP: 180 mg/L and hyperleukocytosis: 13.3 G/L) without other biological abnormalities (lipase: 48 UI/L, ALAT: 48 UI/L). The endoscopic examinations and abdominal CT were normal. The patient was discharged from the hospital without any treatment. Half a month later, the patient was admitted to the Emergency Department for the third time and recurrence of the abdominal pain. The clinical examination found a hemodynamic stability, an abdominal pain of the left hypochondrium associated with a cutaneous ulcerative and non-progressive skin lesion in the same region as previously mentioned (Figure 1b.). The biological assessment found a very mild inflammatory syndrome (CRP 86 mg/L, Procalcitonin < 0.2 ng/mL, leukocytes 9.5 G/L), a high lipase level at 1714 IU/L without hepatocellular abnormalities. The third abdominal CT revealed an aspect of pancreatic necrosis with a pseudocyst (6 cm) at the tail of the pancreas, in contact with the splenic hile and the posterior wall of the stomach (Figure 1c.). The patient was hospitalized in Intensive Care Department with the diagnosis of pancreatitis.