{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T14:43:04Z","timestamp":1765982584478,"version":"3.48.0"},"reference-count":24,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,25]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Hypertriglyceridaemia is a well-documented cause of pancreatitis. Although rare, pancreatitis can result in life-threatening complications such as atypical haemolytic uremic syndrome (aHUS) and secondary haemophagocytic lymphohistiocytosis (sHLH). Our case presents a female in her late 30s with right upper abdominal pain, elevated triglycerides and lipase levels in the background of an undiagnosed genetic hypertriglyceridaemia (HTG). These findings are consistent with the diagnosis of HTG pancreatitis. Her condition deteriorated a week following admission with the development of rhabdomyolysis and aHUS characterised by haemolysis, progressive renal failure and thrombocytopenia. Unremitting fevers ensued during the course of her illness and prompted the diagnosis of sHLH. She was treated with eculizumab and glucocorticoids with eventual resolution of the disease process and restoration of her renal function. Notably, a subsequent aHUS genetic panel returned negative indicating a low risk of further relapse.<\/jats:p>","DOI":"10.1136\/bcr-2025-265010","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T14:40:19Z","timestamp":1765982419000},"page":"e265010","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Hypertriglyceridaemic pancreatitis associated with atypical haemolytic uraemic syndrome and secondary haemophagocytic lymphohistiocytosis: an immune system gone rogue"],"prefix":"10.1136","volume":"18","author":[{"given":"Jeremy","family":"Tse","sequence":"first","affiliation":[{"name":"Gastroenterology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Phan","sequence":"additional","affiliation":[{"name":"Gastroenterology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Zotov","sequence":"additional","affiliation":[{"name":"Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwini","family":"Bennett","sequence":"additional","affiliation":[{"name":"Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia"},{"name":"Hematology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manjeet","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Gastroenterology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"2025121706401301000_18.12.e265010.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2020.06.005"},{"key":"2025121706401301000_18.12.e265010.2","first-page":"S44","article-title":"Complement-driven hemolytic uremic syndrome","volume":"98 Suppl 4","author":"Leon","year":"2023","journal-title":"Am J Hematol"},{"key":"2025121706401301000_18.12.e265010.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2013.08.003"},{"key":"2025121706401301000_18.12.e265010.4","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1007\/s00467-018-4091-3","article-title":"Eculizumab in atypical hemolytic uremic syndrome: strategies toward restrictive use","volume":"34","author":"Wijnsma","year":"2019","journal-title":"Pediatr Nephrol"},{"key":"2025121706401301000_18.12.e265010.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.11.014"},{"key":"2025121706401301000_18.12.e265010.6","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/bjh.14147","article-title":"Advances in the pathogenesis of primary and secondary haemophagocytic lymphohistiocytosis: differences and similarities","volume":"174","author":"Brisse","year":"2016","journal-title":"Br J Haematol"},{"key":"2025121706401301000_18.12.e265010.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8588(05)70521-9"},{"key":"2025121706401301000_18.12.e265010.8","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-302779"},{"key":"2025121706401301000_18.12.e265010.9","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15006"},{"key":"2025121706401301000_18.12.e265010.10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ekir.2020.10.009","article-title":"Complement in Secondary Thrombotic Microangiopathy","volume":"6","author":"Palma","year":"2021","journal-title":"Kidney Int Rep"},{"key":"2025121706401301000_18.12.e265010.11","doi-asserted-by":"crossref","DOI":"10.3390\/ijms241914496","article-title":"Underlying Genetics of aHUS: Which Connection with Outcome and Treatment Discontinuation?","volume":"24","author":"Spasiano","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2025121706401301000_18.12.e265010.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003573","article-title":"A systematic review of eculizumab for atypical haemolytic uraemic syndrome (aHUS)","volume":"3","author":"Rathbone","year":"2013","journal-title":"BMJ Open"},{"key":"2025121706401301000_18.12.e265010.13","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/295323","article-title":"Eculizumab therapy leads to rapid resolution of thrombocytopenia in atypical hemolytic uremic syndrome","volume":"2014","author":"Tsai","year":"2014","journal-title":"Adv Hematol"},{"key":"2025121706401301000_18.12.e265010.14","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-016-0288-3"},{"key":"2025121706401301000_18.12.e265010.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-012-2130-z"},{"key":"2025121706401301000_18.12.e265010.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208981"},{"key":"2025121706401301000_18.12.e265010.17","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s10875-020-00789-4","article-title":"Thinking Beyond HLH: Clinical Features of Patients with Concurrent Presentation of Hemophagocytic Lymphohistiocytosis and Thrombotic Microangiopathy","volume":"40","author":"Gloude","year":"2020","journal-title":"J Clin Immunol"},{"key":"2025121706401301000_18.12.e265010.18","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.27929","article-title":"Challenges in the diagnosis of hemophagocytic lymphohistiocytosis: Recommendations from the North American Consortium for Histiocytosis (NACHO)","volume":"66","author":"Jordan","year":"2019","journal-title":"Pediatr Blood Cancer"},{"key":"2025121706401301000_18.12.e265010.19","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s13045-024-01621-x","article-title":"Hemophagocytic lymphohistiocytosis: current treatment advances, emerging targeted therapy and underlying mechanisms","volume":"17","author":"Wu","year":"2024","journal-title":"J Hematol Oncol"},{"key":"2025121706401301000_18.12.e265010.20","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2018894618"},{"key":"2025121706401301000_18.12.e265010.21","doi-asserted-by":"crossref","unstructured":"Fraga-Rodriguez GM , Bri\u00f3-Sanagustin S , Tur\u00f3n-Vi\u00f1as E , et al . Eculizumab in a child with atypical haemolytic uraemic syndrome and haemophagocytic lymphohistiocytosis triggered by cytomegalovirus infection. BMJ Case Rep 2017;2017. doi:10.1136\/bcr-2016-219065","DOI":"10.1136\/bcr-2016-219065"},{"key":"2025121706401301000_18.12.e265010.22","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12882-024-03548-4","article-title":"An unusual case of adult-onset still\u2019s disease complicated with anti-complement factor H antibodies associated atypical haemolytic uraemic syndrome","volume":"25","author":"Fung","year":"2024","journal-title":"BMC Nephrol"},{"key":"2025121706401301000_18.12.e265010.23","doi-asserted-by":"crossref","unstructured":"Singh K , Nadeem AJ , Doratotaj B . A rare case of thrombotic microangiopathy triggered by acute pancreatitis. BMJ Case Rep 2017;2017. doi:10.1136\/bcr-2016-218581","DOI":"10.1136\/bcr-2016-218581"},{"key":"2025121706401301000_18.12.e265010.24","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1177\/2050640618755002","article-title":"Hypertriglyceridemic pancreatitis: Epidemiology, pathophysiology and clinical management","volume":"6","author":"de Pretis","year":"2018","journal-title":"United European Gastroenterol J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T14:40:21Z","timestamp":1765982421000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,17]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bcr-2025-265010"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265010","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}