HIV associated malignancies presenting as acute pancreatitis: a case series

Abstract

Background: Acute pancreatitis (AP) may be the presenting symptom in a small percentage of patients harbouring pancreatic or extra  pancreatic tumours. This case series aims to describe the pathological spectrum of tumours detected in two AP cohorts from a high HIV-endemic region.

Methods: Prospectively collected databases of patients admitted with AP over two periods 2001 to 2010 and 2013 to 2015, were  retrospectively evaluated to detect those with pancreatic and extra-pancreatic tumours. The diagnosis of AP was by standard criteria. HIV  infection and CD4 counts were routinely tested for in the latter period and only tested on clinical grounds in the initial period. CT scan  was performed when there was diagnostic doubt, predicted severe disease, and failure to improve clinically after one week.  Demographic, clinical, investigative, and pathology details were collected and presented.

Results: HIV-positive patients admitted with AP  were 106 (17%) of 628 in the first period and 90 (38%) of 238 of the second period. No tumours were diagnosed in the HIV-negative  patients. Seven of the HIV-positive patients had tumours diagnosed at endoscopy, CT scan, and endoscopic retrograde cholangiography.  Of the seven HIV-positive patients with tumours, two patients had a CD4 count above 200. There were four patients with lymphoma  involving the pancreatic head, three having associated cholestasis, and three patients with Kaposi’s Sarcoma. One Kaposi’s sarcoma  patient died three months after presentation. One patient with lymphoma died on day 14 and another two months after initial  presentation, and the remaining four patients were referred to oncology.

Conclusion: Despite their rarity (< 4%), when HIV-positive  patients with low CD4 count and cholestasis present with AP, tumours should be suspected and evaluated by cross sectional imaging and  endoscopic ultrasound.