On investigation, blood counts, C-reactive protein (CRP), urinalysis, and liver function tests were normal but serum amylase and lipase were mildly elevated (350 IU/L and 410 IU/L respectively). Ultrasound (USG) abdomen showed hepatomegaly without any features of pancreatitis.She was diagnosed as HSP pancreatitis and because of persistent abdominal pain was initiated on oral prednisolone and discharged. After 6 days of discharge, while on oral prednisolone, she was readmitted with severe abdominal pain and recurrent multiple episodes of vomiting. This time, the pain was severe and generalized as the child presented with an acute abdomen.On examination, the child looked toxic, had tachycardia (heart rate 150 beats/minute) with decreased urine output. The blood pressure was in the normal range. Blood counts showed leukocytosis 22,700/cmm with 81% neutrophils, raised CRP (51.2 mg/L, normal <5), elevated serum amylase (2866 IU/L, normal 0-100), and lipase (2970 IU/L, normal 0-60). Contrastenhanced computed tomography (CECT) of the abdomen revealed acute pancreatitis with a peripancreatic collection without necrosis.Considering the increased clinical severity, she received three pulses of iv methylprednisolone 6 mg/kg/day but as pain abdomen recurred on restarting oral prednisolone, one dose of iv cyclophosphamide 500 mg/m 2 was given. Abdominal pain subsided and she was discharged on oral prednisolone.After 5 days, she was readmitted with a recurrence of generalized abdominal pain, vomiting, and abdominal distension.
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