Understanding Acute Pancreatitis and Leukemoid Reaction: Symptoms, Causes, and Treatment

Introduction

Hemorrhagic fever with renal syndrome (HFRS) is a serious infectious disease caused by the Hantaan virus (HTNV). This virus mainly spreads through rodents, which carry the infection in their blood, urine, and feces. Humans can contract the virus via direct contact or aerosols. HFRS primarily causes fever, shock, bleeding, and kidney damage. HTNV infects endothelial cells, increasing vascular permeability and causing fluid leakage. The infection triggers strong immune responses that can result in damage to multiple organs, including the lungs and heart.

HFRS often starts with symptoms like headache, eye pain, and lower back pain. Patients may show facial redness and experience a range of bleeding signs. The disease progresses through five stages: fever, hypotensive shock, reduced urine output, increased urine output, and recovery. Serious complications include pulmonary edema, heart issues, brain hemorrhaging, and acute kidney failure.

Case Presentation

A 20-year-old male from Hunan province, China, exhibited symptoms of fever and dizziness starting four days prior to admission. He also experienced abdominal pain, nausea, and vomiting. Initial CT scans suggested acute pancreatitis. His symptoms worsened, prompting his transfer to a specialized hospital. He reported having wild mice around his home.

Upon admission, he had a fluctuating temperature and significant tachycardia. His blood pressure was critically low (84/52 mmHg). Laboratory tests showed an extremely high white blood cell count and a drastic drop in platelets. Liver functions were abnormal, and renal function tests indicated kidney stress with elevated creatinine levels.

Follow-up imaging confirmed significant pancreatic swelling and surrounding fluid. Bone marrow analysis revealed signs of active hematopoiesis and an atypical lymphocyte population. A test for HTNV antibodies confirmed the virus’s presence. The treatment included anti-infective medication and support for pancreatic function. Despite initial improvements, the patient experienced a decline in urine output and oxygen levels, necessitating further respiratory support.

Discussion

HFRS cases presenting with leukemoid reactions and pancreatitis are rare. HTNV infection impairs platelet function and count, affecting bleeding and clotting. In this case, the patient’s platelet levels fell sharply but began to recover by day 13. Elevated white blood cell counts, particularly lymphocytes, suggested a significant immune response.

The leukemoid reaction likely results from complex immune interactions involving neutrophils, monocytes, and lymphocytes. The patient’s condition underscores the need for clinicians to recognize atypical symptoms of HFRS, particularly in endemic regions, to prevent severe outcomes.

Conclusion

This case illustrates a unique instance of HFRS with acute pancreatitis and a leukemoid reaction. Early diagnosis and prompt treatment are crucial for successful outcomes. Healthcare providers in areas with high incidence rates of HFRS must remain vigilant for unusual presentations to improve patient care and prevent outbreaks.

Abbreviations

HFRS: hemorrhagic fever with renal syndrome
HTNV: Hantaan virus
APACHE II: acute physiology and chronic health evaluation
SOFA: sequential organ failure assessment
WBC: white blood cell count
ALT: alanine aminotransferase
AST: aspartate aminotransferase
Cr: creatinine
BUN: blood urea nitrogen
LDH: lactate dehydrogenase
CK: creatine kinase
CT: computed tomography
AP: acute pancreatitis

Ethics Approval and Informed Consent

The patient provided consent for this case report. The clinical ethics committee of Xiangya Hospital approved the report.

Acknowledgments

Thanks to the staff at the emergency Intensive Care Unit and the supporting clinical departments. We also thank the patient and their family for their cooperation.