Severe hypertriglyceridemia in adults-management considerations in a rare clinical case
Keywords:
severe hypertriglyceridemia, acute pancreatitis, plasmapheresisAbstract
Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a medical emergency requiring early diagnosis and rapid treatment to prevent severe complications and recurrences. The objective of this study is to explore, through a particularly rare clinical case, the etiology, pathophysiology, diagnosis, and management strategies for severe hypertriglyceridemia in adults. We present a rare clinical case of severe hypertriglyceridemia from the Clinic of Gastroenterology at USMF „Nicolae Testemițanu,” analyzed in light of current management possibilities according to specialized literature. A 44-year-old patient was diagnosed in 2024 with severe hypertriglyceridemia (TG > 40 mmol/l) and hypercholesterolemia (Total Cholesterol > 6.0 mmol/l). Amylase or lipase levels were not elevated, but imaging revealed hepatosplenomegaly, advanced steatosis, and moderate liver fibrosis. The patient had a history of PA episodes complicated by pancreonecrosis, with an unspecified etiology. Plasmapheresis rapidly reduced triglycerides, but without a sustained long-term effect, and combined lipid-lowering therapy proved insufficient to prevent further complications. Subsequently, the patient presented with an episode of acute pancreatitis (PA) complicated by pancreatic necrosis. Genetic testing and family screening were recommended to consider initiating new therapeutic methods. This case highlights that early diagnosis and emerging therapies for severe hypertriglyceridemia are vital for preventing pancreatic complications. Furthermore, it illustrates the complexity of managing recurrent HTG-AP, emphasizing the essential role of plasmapheresis for rapid and effective management.
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