Diagnostic Dilemma

Increased amylase in HIV infected child

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}.

What is the cause of asymptomatic elevation of amylase_?
Expert Opinion :
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.
Answer Discussion :
dr.ankur patel
drug induced pancreatitis
12 years ago
shanthi shanthi
Asymptomatic elevated amylase is known to occur with ART in children. Probably due to drugs
12 years ago

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