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Journal of Medical Cases

Case Report

Volume 3, Number 3, June 2012, pages 167-168

Acute Pancreatitis Associated With Campylobacter jejuni Enteritis: A Case Report

Many infectious agents are associated with acute pancreatitis, including viruses, fungi, parasites, and enteric bacteria [1]. A study reported by Tositti et al [2] found that while hyperamylasemia is relatively common in patients with acute gastroenteritis (10.2 % of 507 consecutive patients), overt pancreatitis in these patients was a rare occurrence. Elevation of pancreatic enzymes without mention of overt pancreatic inflammation has been reported in association with Campylobacter jejuni infection in a small number of patients [3-7]. To our knowledge, only a single case of acute pancreatitis with imaging evidence of pancreatic inflammation has been reported previously [8]. We report a case of acute pancreatitis with computed tomography (CT) evidence of pancreatic inflammation associated with C. jejuni enteritis.

A 62-year-old male presented with a history of loose stools, nausea, vomiting, fatigue, and rapid weight loss. He had abdominal pain and tenderness centered in the epigastrum but had a non-surgical abdomen. He denied black or bloody stools. His past medical history was remarkable for hypertension, glucose intolerance, pancreatic insufficiency, and cholecystectomy. Temperature was not elevated. No significant postural changes in blood pressure were noted, but pulse increased from 67 to 90 going from supine to standing.

Laboratory findings included a serum amylase level of 358 U/L (normal range 28 - 100 U/L) and lipase level of 637 U/L (normal range 16 - 63 U/L). Sodium and potassium were normal. BUN was 25.0 mg/dL (normal range 6 - 23 mg/dL) and creatinine was 1.50 mg/dL (normal range 0.4 - 1.3 mg/dL). Peripheral white count, hematocrit and platelets were normal.

The patient was admitted to the hospital and a CT scan of the abdomen was performed, which showed evidence of mild, acute pancreatic inflammation. No cause of pancreatitis was identified. He was treated with supportive measures including IV fluids and nausea and pain medications. Amylase and lipase levels improved daily. Because diarrhea persisted, a stool culture was performed and yielded C. jejuni. The patient’s improvement by the time culture results were available was satisfactory enough that he was not started on antibiotics.

Common manifestations of C. jejuni enteritis are diarrhea, abdominal pain or cramps, malaise, nausea, vomiting, anorexia, fever, chills and sweats and gross blood in stool. In a study involving 188 hospitalized patients with C. jejuni enteritis, pancreatitis (as determined by elevated serum amylase or lipase values) was found in 11 patients [6]. The mechanism responsible for elevated amylase levels in bacterial enteritis is not completely understood and may be the result of several different mechanisms. It has been reported in the case of campylobacter cholecystitis that the organism can gain access to the biliary tract [9]. Immune or perfusion injury may also be involved in some patients. It is possible that patients with and without imaging evidence of inflammation in reports of C. jejuni associated pancreatitis simply represent a continuum of very mild to more severe disease. However, there are patients who do appear to have elevated pancreatic enzymes without typical symptomatic or imaging evidence of pancreatitis as pointed out by Tositti et al. [2]. It seems likely that these are cases of hyperamylasemia without pancreatitis per se. In this setting, hyperamylasemia associated with bacterial enteritis might be analogous to the occurrence of elevated amylase that sometimes happens with nonspecific bowel injury such as in bowel obstruction or perforation.

This case is an example of the infrequent occurrence of pancreatitis in persons with C. jejuni enteritis. At least one case of pancreatic edema associated with C. jejuni enteritis has been reported previously [8]. Other previously reported cases of pancreatitis associated with C. jejuni enteritis [2-7] showed elevated pancreatic enzymes without mention of pancreatic inflammation on imaging.

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Conflict of Interest

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1. Parenti DM, Steinberg W, Kang P. Infectious causes of acute pancreatitis. Pancreas. 1996;13(4):356-371.
   pubmed doi
2. Tositti G, Fabris P, Barnes E, Furlan F, Franzetti M, Stecca C, Pignattari E, et al. Pancreatic hyperamylasemia during acute gastroenteritis: incidence and clinical relevance. BMC Infect Dis. 2001;1:18.
   pubmed
3. Kandula L, Khan S, Whitcomb DC, Lowe ME. Acute pancreatitis in association with Campylobacter jejuni-associated diarrhea in a 15-year-old with CFTR mutations: is there a link? JOP. 2006;7(5):482-485.
   pubmed
4. Ponka A, Kosunen TU. Pancreas affection in association with enteritis due to Campylobacter fetus ssp. jejuni. Acta Med Scand. 1981;209(3):239-240.
   pubmed
5. Ezpeleta C, de Ursua PR, Obregon F, Goni F, Cisterna R. Acute pancreatitis associated with Campylobacter jejuni bacteremia. Clin Infect Dis. 1992;15(6):1050.
   pubmed doi
6. Pitkanen T, Ponka A, Pettersson T, Kosunen TU. Campylobacter enteritis in 188 hospitalized patients. Arch Intern Med. 1983;143(2):215-219.
   pubmed doi
7. de Bois MH, Schoemaker MC, van der Werf SD, Puylaert JB. Pancreatitis associated with Campylobacter jejuni infection: diagnosis by ultrasonography. BMJ. 1989;298(6679):1004.
   pubmed doi
8. Castilla-Higuero L, Castro-Fernandez M, Guerrero-Jimenez P. Acute pancreatitis associated with Campylobacter enteritis. Dig Dis Sci. 1989;34(6):961-962.
   pubmed doi
9. Mertens A, De Smet M. Campylobacter cholecystitis. Lancet. 1979;1(8125):1092-1093.
   pubmed doi

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Journal of Medical Cases is published by Elmer Press Inc.