Plasmapheresis as a Life-Saving Measure for Severe Hypertriglyceridemia-Induced Acute Pancreatitis

Severe hypertriglyceridemia (HTG) presenting as acute pancreatitis (AP) in the setting of diabetic ketoacidosis (DKA) is a rare combination, reported as the enigmatic triad in literature. Here we present a case of a 26-year-old woman, with diabetes mellitus (DM) for three years, who presented with features suggestive of acute pancreatitis complicated with DKA in addition to systemic inflammatory response syndrome (SIRS) and acute respiratory distress syndrome (ARDS). Evaluation revealed severe HTG to the tune of 9947 mg/dL. She was managed with insulin infusion combined with three sessions of plasmapheresis, which led to marked clinical and biochemical improvement. This case highlights the importance of plasmapheresis as a lifesaving therapeutic option for severe HTG-induced AP.