Therapeutic plasma exchange for the treatment of hypertriglyceridemia-induced pancreatitis: A case report

A rare but serious form of pancreatitis is caused by severe hypertriglyceridemia. It accounts for up to 10 % of all acute pancreatitis episodes. Despite a pathophysiology that differs distinctly from other forms of pancreatitis, there are no accepted guidelines for the treatment of hypertriglyceridemia-induced pancreatitis. We report a morbidly obese (BMI 45 kg/m²) 36-year-old Caucasian woman with a history of schizophrenic psychosis who was transferred to our tertiary care hospital for further diagnosis and treatment of increasing abdominal pain and hypertryglyceridemia of 2757 mg/dl. Due to rapid clinical deterioration, requiring invasive mechanical ventilation we performed therapeutic plasma exchange (TPE). About 1.5 times of the patient’s calculated plasma volume was exchanged using fresh frozen plasma as substitution fluid. After a single TPE the triglyceride levels decreased by 86 % to 387 mg/dl. Concomitantly C‑reactive protein decreased from 303 to 179 mg/dl. Despite the paucity of data, TPE may be a beneficial means to lower triglycerides in patients with hypertriglyceridemia-induced pancreatitis, due to the rapid removal of the causative agent leading to pancreatic injury.