From hyperamylasemia to salmonella pancreatitis: a case report

Background. Hyperamylasemia is a phenomenon not uncommon in clinical practice, and its immediate cause needs to be identified. Usually, increased blood amylase levels are considered as part of the involvement of the pancreas in the pathological process in pancreatitis, traumatic injuries, pancreatic tumors. However, there is a fairly wide range of so-called extrapancreatichyperamylasemias, including a variety of conditions – pathology of the salivary glands, a wide range of surgical diseases, paraneoplastic manifestations, and a recently described state of macroamylasemia. The diagnostic process in patients with hyperamylasemia has not been fully established and sometimes can be challenging.

Objective. The article presents a clinical case of acute enterocolitis in a young man, accompanied by increased blood amylase levels.

Results. A clinical case of detecting a high blood amylase level in a patient with acute gastroenteritis is presented. Subsequent study led to the diagnosis of acute Salmonella pancreatitis that developed secondary to Salmonella enterocolitis. The article describes the differential diagnosis process to identify the cause of increased blood amylase levels and rule out various causes of extrapancreatic hyperamylasemia. An example of calculation of the amylase-to-creatinine clearance ratio used for the differential diagnosis of macroamylasemia is presented. The discussion presents the literature on the characteristics of pancreatitis manifestations in the context of salmonellosis. This pathology is regarded as rare. According to the literature, which is consistent with the discussed clinical case, pancreatitis in salmonellosis usually has certain characteristics: a mild course without severe pain, manifested mainly by hyperamylasemia and/or hyperlipasemia, often not requiring aggressive treatment. A catamnesis is presented – observation of the patient at two and five months after the initial hospitalization; it showed the disappearance of complaints and the gradual normalization of laboratory results.

Conclusion. Understanding the reasons for increased blood amylase levels in patients with salmonellosis can help in the diagnosis of an uncommon manifestation of Salmonella pancreatitis.

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