Case Report: Right flank pain as the only symptom for acute pancreatitis in a patient on treatment for HIV infection

Acute pancreatitis often presents with severe epigastric pain and referred pain to the back. In practice,  epigastric pain of pancreatitis may also occasionally present with associated left sided flank pain. Here, we present a case of a 38 year old man on antiretroviral therapy for HIV infection, who came with severe right  sided lumbar pain to the emergency department. The initial abdominal ultrasonogram was normal and the patient was misdiagnosed as possible renal associated pain. The CECT scan done the following day showed acute pancreatitis with peripancreatic fat stranding, fluid upto the right perinephric space and thickening of pararenal fascia. Urinalysis and renal function tests were within normal limits. On literature search, we could not find any reported cases of acute pancreatitis with right lumbar pain as the only presenting symptom.  Patients taking anti-retroviral therapy develop pancreatitis most commonly due to hypertriglyceridemia. However, this patient had a normal lipid profile. On ruling out other causes, we conclude that his pancreatitis was caused by Azatanavir, which has only post marketing reports of pancreatitis and we could find no specific study linking the drug to the disease. KEY WORDS : Pancreatitis; HIV infection; ART; Azatanavir