Successful treatment with plasmapheresis of severe hypertriglyceridemic acute pancreatitis complicated by fat overload syndrome caused by lipid injectable emulsion: a case report and review of the literature

BACKGROUND: Hypertriglyceridemic acute pancreatitis (HTG-AP) and fat overload syndrome caused by lipid injectable emulsion (ILE) are rare in clinical practice. Although the treatment of HTG-AP with plasmapheresis has previously been reported, only a few reports describe the application of plasmapheresis to treat HTG-AP and fat overload syndrome caused by ILE. CASE PRESENTATION: We report a case diagnosed with severe HTG-AP and fat overload syndrome, based on laboratory findings and abdominal computed tomography, caused by intravenous infusion of ILE for about 3 weeks without monitoring of serum triglyceride (TG) levels in a 78-year-old Chinese female patient with a history of esophageal cancer. Conventional treatments were attempted; however, the patient progressively developed worsening abdominal pain and notably elevated inflammatory biomarkers, including C-reactive protein and procalcitonin levels. Plasmapheresis treatment was performed immediately to lower serum TG levels and prevent the complication of acute pancreatitis (AP) due to hypertriglyceridemia. After two consecutive plasmapheresis sessions, the patient's TG and total cholesterol levels remarkably decreased to 13.57 and 8.62 mmol/L, respectively. She also showed considerable improvement in her abdominal symptoms. CONCLUSION: HTG-AP and fat overload syndrome can be associated with intravenous infusion of ILE. Monitoring serum TG levels while utilizing ILE is necessary. Plasmapheresis should be considered an effective treatment measure for severe HTG-AP or fat overload syndrome caused by ILE, because it rapidly lowers serum TG levels and may prevent to be useful in ameliorating the course of acute pancreatitis.