Diagnostic Dilemma - Pediatric Oncall
Increased amylase in HIV infected child
Author: Pediatric Oncall
A 5½ years old HIV infected boy was referred for further management. He had recurrent cough and cold. On examination weight was 13 kg. He had generalized lymphadenopathy oral thrush, clubbing and pallor. Systemic examination was normal. CD4 count was 143 cells, cumm. USG abdomen was normal. He was treated with clotrimazole mouth paint and started on anti retroviral therapy {ART} consisting of Zidovudine {AZT}, Lamivudine {3TC} and Efavirenz {NVP}. After 1 month of starting ART, his amylase increased to 899 U, L though child was asymptomatic. USG Abdomen showed bulky pancreas. His amylase were serially monitored and depicted in Table 1. The child continues to be asymptomatic. has no parotid enlargement, has put on 4.5 kg in next 2½ years and CD4 count at 8 years is 1435 {30 percent}.
Answers of this discussion
Author :- drRanjith kumar on 10 October 2011.
Answer :- drugs

Author :- prawin agarwal on 10 October 2011.
Answer :- it is related to zidovudine

Author :- Pediatric Oncall on 10 October 2011.
Answer :- Thanks for the replies. If it was due to drugs, then the pancreatitis is usually due to mitochondrial dysfunction in which case there should also be lactic acidosis. Moreover the child is otherwise doing fine.

Author :- shanthi shanthi on 11 October 2011.
Answer :- Asymptomatic elevated amylase is known to occur with ART in children. Probably due to drugs

Author :- dr.ankur patel on 15 October 2011.
Answer :- drug induced pancreatitis

Author :- Pediatric Oncall on 17 October 2011.
Answer :- The child was contined on ART. Infact over a period of time, the amylase came down on its own. We assume this to be HIV induced pancreatitis since on the drugs, the amylase did come down which should not have occured since the drugs were contined.

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