Hemophagocytic syndrome as a complication of acute pancreatitis: A case report

Figure 1 Results of examinations. A: Detailed therapeutic measures taken for the patient with acute pancreatitis during the time of hospitalization. Nutrition support therapy included 5% glucose, compound sodium chloride, hetastarch, mix sugar electrolyte, fructose, compound amino acid peptide, glutamine dipeptide, multi-vitamin, and fish oil fat emulsion; B: Temperature change curve of the patient. The measuring frequency was four times a day; C: Jejunum nutrition tube was placed by gastroscopy; D-G: Changes of amylase, lipase, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin during hospitalization.

Figure 2 Images of abdominal computed tomography. A and B: Contrast-enhanced computed tomography imaging of the pancreas showed pancreatic swelling, peripancreatic infiltration, and bilateral fascia thickening on the fourth day of hospitalization; C and D: The pancreatic swelling and peripancreatic fluid collections were meliorated on day 13; E and F: The peripancreatic seepage almost recovered on day 23.

Figure 3 Images of thoracic computed tomography. A and B: On the fourth day, thoracic computed tomography showed bilateral pleural effusion with partially encapsulated effusion. The lungs also showed scattered linear and lamellar high-density shadows, which were considered to be due to an infectious disease; C and D: Thoracic computed tomography indicated that encapsulated effusion was gradually absorbed but the left lung showed segmental atelectasis on day 13; E and F: Bilateral pleural effusion completely disappeared and segmental atelectasis was recovered on day 23.

Figure 4 Changes of indexes after effective treatment. A-E: Changes of platelets and serum levels of alanine aminotransferase, aspartate amino transferase, triglyceride, ferritin, and lactic acid dehydrogenase during hospitalization; F: The patient suddenly developed skin rash; G: No obvious abnormality was found in the peripheral blood smear (original magnification, 1 × 10³); H: Overactive macrophage phagocytosis, erythrocytes, leucocytes, platelets, and their precursors were also not found in the bone marrow aspiration specimen (original magnification, 1 × 10³). ALT: Alanine aminotransferase; AST: Aspartate amino transferase.