Rotavirus gastroenteritis and a rare case accompanying acute pancreatitis

Pancreatitis in children is inflammation of the pan-creas gland which presents with epigastric abdominal pain and elevated levels of digestive enzymes, and it is an important cause of mortality and morbidity [1]. Although hyperamylasemia and hyperlipasemia are relatively frequently seen in gastroenteritis, pancreatitis is very uncommon [2]. Rotavirus infection and pancreatitis together are seen very rarely [3]. In this article, we present a case where rotavirus gastroenteritis was accompanied by acute pancreatitis which presented with acute diarrhea. A 5-year-old male patient presented with abdominal pain, vomiting and diarrhea. In his history, he had diarrhea that started 5 days ago, vomiting and epigastric pain which became worse in the last 2 days. Family history did not reveal anything. Physical examination showed nothing apart from epigastric tenderness and increased bowel movement sounds. Laboratory results showed he-moglobin (Hb) 12.5 g/dl (normal range: 12–16), leuko-cytes (WBC) 3700/mm 3 (normal range: 4800–10 800), lymphocytes 1000/mm 3 (normal range: 1300–3500), neutrophils 1930/mm 3 (normal range: 2060–7020), eosinophils 40/mm 3 (normal range: 0–420), platelets (PLT) 272 000/mm 3 (normal range: 150 000–450 000), alanine aminotransferase (ALT) 187 U/l (normal range: 0–41), aspartate transaminase (AST) 100 U/l (normal range: 0–40), g-glutamyl transferase (GGT) 38 U/l (normal range: 10–61), total bilirubin 0.26 mg/dl (normal range: 0.1–1.2), direct bilirubin 0.12 mg/dl (normal range: 0–0.2), prothrombin time (PT) 13.12 s (normal range: 10.4–14), international normalized ratio (INR) 1.15, activated partial thromboplastin time (aPTT) 18.5 s (normal range: 21–36.5), C-reactive protein (CRP): 23 mg/dl (normal range: 0–0.5), pancreatic amylase 1230 U/l (normal range: 28–100), lipase 810 U/l (normal range: 13–60). Total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol , very low-density lipoprotein (VLDL) cholesterol, triglycerides, serum electrolytes, kidney function tests, urine analysis, and hepatic markers were all normal. Abdominal ultrasound (USG) demonstrated a mildly enlarged edematous pancreas and ultrasonography one month later showed that this had normalized. Stool samples were positive for rotavirus antigen and negative for adenovirus antigen using the VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux). Oral intake was stopped and total parenteral nutrition was started along with intravenous lansoprazole. During the follow-up, the patient was doing well and control laboratory results showed ALT 42 U/l, AST 56 U/l, GGT 24 U/l, total bilirubin 0.5 mg/dl, direct bil-irubin 0.1 mg/dl, CRP 0.3 mg/dl, pancreatic amylase 42 U/l, lipase 24 U/l. He was switched to full oral feeding by incrementally increasing oral intake. The patient was discharged and followed by the …