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July 2002

Amelie is a 12 year-old girl vertically infected with HIV. She is currently being treated with Combivir (lamivudine/zidovudine) and Kaletra (lopenivir/ritonavir). She presents in clinic today with vomiting, loss of appetite and fever. On physical examination you note some peri-umbilical pain but no guarding or rebound. She also complains of right shoulder pain. Bowel sounds are normal. Laboratory studies reveal the following:

Electrolytes, creatinine, and blood urea nitrogen are all normal; liver enzymes, bilirubin, triglycerides and cholesterol are mildly elevated; amylase 163 U/L (normal 5-15 U/L), lipase 4067 U/L (normal 15-110 U/L); urine chemistry and microscopy are normal

An abdominal ultrasound shows a mildly enlarged pancreas with decrease echogenicity.

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