Abstract

Background: Acute pancreatitis is an inflammatory condition of the pancreas characterized by a wide spectrum of clinical severity, ranging from mild, self-limiting to severe necrotizing disease with high morbidity and mortality. Patients with pancreatitis can have variable presentations, and diagnosis is based on clinical features, amylase level, lipase level, and computed tomography (CT). A threefold or more than the normal level of serum amylase and lipase is considered diagnostic for acute pancreatitis. In the literature, normal serum amylase levels have been reported. However, serum lipase is usually elevated. It is an extremely rare occurrence to have a normal serum lipase level in the context of acute pancreatitis.
Case Presentation: Here, we report a case of a 38-year-old male who presented to the emergency department with 2 days history of right upper quadrant pain, nausea, and constipation. Laboratory workup, including full blood count, amylase, lipase, liver function tests, and lipid profile, was within normal limits. Further evaluation with computed tomography revealed findings consistent with acute pancreatitis despite normal serum amylase and lipase levels.
Conclusion: This case highlights the importance of recognizing atypical presentations of acute pancreatitis. Reliance solely on serum lipase is insufficient to exclude the diagnosis and should prompt further radiological evaluation to identify those atypical cases when clinical suspicion persists.

Key words: Pancreatitis, Amylase, Lipase, Emergency Medicine, Case Report