SHM Converge Scientific Abstract ePoster Gallery-The Misleading Fever Curve: A Challenging Case of Hypertriglyceridemia-Induced Acute Pancreatitis

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This case describes an uncommon initial presentation of type 2 diabetes with the triad of diabetic ketoacidosis (DKA), severe hypertriglyceridemia, and acute pancreatitis. The diagnostic workup confirmed marked hypertriglyceridemia (TG 4,400 mg/dL), DKA, and new type 2 diabetes, while broad infectious, cardiac, thromboembolic, and imaging evaluations were largely negative for an alternative source of fever.<br /><br />The patient developed persistent fevers during hospitalization, raising concern for infected pancreatic necrosis or another occult infection. However, serial abdominal CT and MRCP showed no necrosis or abscess, only pancreatitis, and chest imaging suggested atelectasis with a small pleural effusion rather than clear pneumonia. Blood and urine cultures, respiratory and gastrointestinal infectious studies, tuberculosis testing, RPR, and other evaluations were negative. TTE showed no endocarditis, and workup for DVT and pulmonary embolism was also negative.<br /><br />The discussion highlights that the DKA–severe hypertriglyceridemia–pancreatitis triad is associated with greater inpatient risk and that fever in acute pancreatitis can reflect either sterile inflammation or infection. In this case, procalcitonin remained low, supporting the absence of infected necrosis, whereas CRP and ESR were elevated but nonspecific. Because the patient remained clinically stable and imaging did not show infectious complications, the fevers were interpreted as likely due to sterile pancreatic inflammation rather than bacterial infection. This supported antibiotic de-escalation despite ongoing fever.

Asset Subtitle

Megan Roach

Meta Tag

Author List Lana Bridi, Megan Roach, Nirja Shah, Sarah F. Horman

Category Clinical Vignettes

Concept Diabetic Ketoacidosis

Concept Hypertriglyceridemia

Concept Acute Pancreatitis

Concept Suspected Infected Necrosis

Concept Pancreatic Necrosis

Distinguished Non-Finalist

Presenter Organization University of California, San Diego

Presenting Author Megan Roach

Track Adult

Keywords

type 2 diabetes

diabetic ketoacidosis

severe hypertriglyceridemia

acute pancreatitis

hypertriglyceridemic pancreatitis

fever

infected pancreatic necrosis

procalcitonin

sterile inflammation

antibiotic de-escalation

Diabetic Ketoacidosis

Hypertriglyceridemia

Acute Pancreatitis

Suspected Infected Necrosis

Pancreatic Necrosis