Bruising as the first sign of exocrine pancreatic insufficiency

Authors

  • Csilla Enikő Szabo "Iuliu Hațieganu University of Medicine and Pharmacy"
  • Oana Iulia Man Children’s Clinical Hospital of Cluj-Napoca
  • Radu Sorin Șerban "Iuliu Hațieganu University of Medicine and Pharmacy"
  • Eva Kiss "Iuliu Hațieganu University of Medicine and Pharmacy"
  • Călin Florin Lazăr "Iuliu Hațieganu University of Medicine and Pharmacy"

DOI:

https://doi.org/10.15386/mpr-1231

Keywords:

bruising, vitamin K deficiency, steatorrhea, malabsorption, exocrine pancreatic insufficiency

Abstract

Exocrine pancreatic insufficiency is an important cause of chronic malnutrition, secondary to maldigestion-malabsorption, which can be caused in children especially by cystic fibrosis, but also by other much rarer diseases. The case of a 6 months and 3 weeks old male pediatric patient is reported, who was admitted to the clinic for head and forearms bruising. Laboratory findings identified vitamin K deficiency as the cause of the cutaneous hemorrhagic syndrome. Further investigations revealed association of steatorrhea (which is a marker of fat malabsorption), iron-deficiency anemia and hypovitaminosis D, which had been produced by nutritional deficiencies caused by malabsorption syndrome. From the numerous disorders that could be associated with pancreatic insufficiency in children, the following conditions had been excluded: cystic fibrosis (mucoviscidosis), cow`s milk protein intolerance, gluten-sensitive enteropathy (coeliac disease), Shwachman-Diamond syndrome, abetalipoproteinemia, etc. Based upon decreased levels of stool pancreatic elastase in repeated measurements, together with low serum lipase, the final diagnosis of exocrine pancreatic insufficiency was established. Treatment of this case consisted mainly in pancreatic enzyme replacement therapy, but also oral iron supplementation and dietary supplements with fat-soluble vitamins (A, D, E, K). The outcome was favorable, characterized by normalization of intestinal passage, ascending growth curve and normalization of the majority of laboratory tests values that were modified between the time of patient admission to our clinic and initiation of specific therapy (serum level of vitamin K, vitamin D and lipase, coagulation profile, hemoglobin and red blood cell indexes), as well as higher value of fecal pancreatic elastase.

 

 


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Published

2019-04-24

How to Cite

1.
Szabo CE, Man OI, Șerban RS, Kiss E, Lazăr CF. Bruising as the first sign of exocrine pancreatic insufficiency. Medicine and Pharmacy Reports [Internet]. 2019 Apr. 24 [cited 2025 May 22];92(2):200-4. Available from: https://medpharmareports.com/index.php/mpr/article/view/1231

Issue

Section

Case Report