Role of Therapeutic Plasma Exchange in Severe Hypertriglyceridemia-Induced Acute Pancreatitis Associated With Preeclampsia: A Case Report.

Acute pancreatitis during pregnancy is an uncommon but serious condition associated with significant maternal and fetal morbidity. Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a severe etiology that presents unique diagnostic and management challenges, particularly when complicated by preeclampsia. Diagnosis may be difficult because clinical manifestations can overlap with those of other obstetric emergencies. We report the case of a 30-year-old woman at 33 weeks' gestation with a history of type 2 diabetes mellitus and chronic hypertension who presented with severe abdominal pain, headache, hypertension, and proteinuria. Laboratory investigations demonstrated severe hypertriglyceridemia (>50 mmol/L) and elevated pancreatic enzymes, confirming severe HTG-AP complicated by preeclampsia and impending preterm labor. The patient was managed through a multidisciplinary approach involving obstetrics, intensive care, endocrinology, gastroenterology, and anesthesia teams. Initial treatment included bowel rest, intravenous fluid resuscitation, insulin-dextrose infusion, and therapeutic plasma exchange (TPE). Following two sessions of TPE, serum triglyceride levels decreased markedly, accompanied by significant clinical and biochemical improvement. However, worsening abdominal pain and non-reassuring cardiotocography findings necessitated emergency cesarean delivery, resulting in the successful birth of a healthy preterm neonate. Both maternal and neonatal outcomes were favorable, and the patient was discharged in a stable condition. This case highlights the importance of prompt recognition of HTG-AP during pregnancy, particularly when accompanied by preeclampsia, and underscores the value of multidisciplinary collaboration in optimizing maternal and fetal outcomes. Therapeutic plasma exchange may serve as an effective strategy for rapid triglyceride reduction in selected patients with severe disease.