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1
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Feng L, Hong Y, Fan J, Yang C, Huang Y, Xu Y, Liao G, Su Y. Clinical characteristics and risk factors of tigecycline-induced acute pancreatitis in kidney transplant recipients: a retrospective study. J Antimicrob Chemother 2025:dkaf159. [PMID: 40405828 DOI: 10.1093/jac/dkaf159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 05/07/2025] [Indexed: 05/24/2025] Open
Abstract
OBJECTIVE Acute pancreatitis (AP) is a severe but insufficiently recognized adverse effect of tigecycline in kidney transplant (KT) recipients. This study aimed to identify the clinical characteristics and risk factors associated with tigecycline-induced AP in this population. METHODS A single-center retrospective study was conducted in KT recipients treated with tigecycline. The clinical characteristics of patients who developed AP were analyzed, and risk factors for tigecycline-induced AP were assessed using univariate analysis and multivariate logistic regression. RESULTS 80 KT recipients were enrolled, of whom nine developed AP (incidence: 11.25%), and four died. The mean time from tigecycline administration to AP onset was 7.00 days, to symptomatic relief after discontinuation was 4.87 days, and to normalisation of pancreatic enzymes after discontinuation was 8.75 days. The analysis revealed that tacrolimus trough concentration (C0 Tac) and post-transplant acute kidney injury (AKI) were independent risk factors for tigecycline-induced AP in KT recipients. Logistic regression analysis produced a combined predictive expression: Ycombined = AKI + 0.064C0 Tac-2.789. Receiver operating characteristic curve analysis determined that the C0 Tac cut-off was 13.9 ng/mL. The area under the curve for C0 Tac and combined predictor were 0.802 and 0.853, respectively. CONCLUSION The incidence of AP following tigecycline treatment was significantly higher in KT recipients than in non-transplant patients. Post-transplant AKI and elevated C0 Tac concentrations were identified as independent risk factors for the development of AP. Close monitoring of renal function and ensuring therapeutic monitoring of C0 Tac levels may help prevent AP.
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Affiliation(s)
- Lijuan Feng
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Yuanyuan Hong
- Department of Pharmacy, The Second People's Hospital of Hefei, Hefei, China
| | - Jiawang Fan
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Chunlan Yang
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Yan Huang
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Yuanbao Xu
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Guiyi Liao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong Su
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, School of Pharmacy, Anhui Medical University, Hefei, China
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Cribari C, Tierney J, LaGrone L. Managing complicated pancreatitis with more knowledge and a bigger toolbox! Trauma Surg Acute Care Open 2025; 10:e001798. [PMID: 40400730 PMCID: PMC12094121 DOI: 10.1136/tsaco-2025-001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Accepted: 03/30/2025] [Indexed: 05/23/2025] Open
Abstract
Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer's solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to 'rest the pancreas', recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%-75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.
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Affiliation(s)
- Chris Cribari
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
- Trauma and Acute Care Surgery, University of Colorado Health, Loveland, Colorado, USA
| | | | - Lacey LaGrone
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
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3
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Bulut ÖF, Karayağmurlu A. Recurrent Pancreatitis Associated With Atomoxetine Use in a 9-Year-Old Boy: A Case Report. J Clin Psychopharmacol 2025; 45:48-49. [PMID: 39608371 DOI: 10.1097/jcp.0000000000001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
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Xu Q, Sang Y, Zhang H, Zhao Q. Possible omadacycline induce acute pancreatitis: a case report and literature review. BMC Infect Dis 2024; 24:1072. [PMID: 39350067 PMCID: PMC11440753 DOI: 10.1186/s12879-024-09983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Omadacycline is a new generation of tetracycline antibiotics, and its clinical application is increasing. We report the first case of acute pancreatitis possibly induced by omadacycline. CASE PRESENTATION The patient was admitted to the emergency intensive care unit due to community-acquired pneumonia. The initial treatment consisted of meropenem combined with levofloxacin, and the regimen was subsequently switched to omadacycline combined with cefoperazone/sulbactam due to sputum culture showing carbapenem-resistant Acinetobacter baumannii. Seven days after the administration of omadacycline, abdominal tenderness occurred, and CT scan revealed an enlarged gallbladder with exudation from the pancreatic head. The patient was diagnosed with acute pancreatitis and improved after dis-continuing omadacycline. CONCLUSIONS Omadacycline, like other tetracycline antibiotics, may cause pancreatitis. Combination medications can be an important factor in this adverse reaction.
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Affiliation(s)
- Qiang Xu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Key Laboratory of Drug Evaluation and Clinical Research, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Clinical Evaluation and Translational Research, Hangzhou, China
| | - Yanlei Sang
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Key Laboratory of Drug Evaluation and Clinical Research, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Clinical Evaluation and Translational Research, Hangzhou, China
| | - Huanran Zhang
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, China
| | - Qingwei Zhao
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
- Zhejiang Provincial Key Laboratory of Drug Evaluation and Clinical Research, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Clinical Evaluation and Translational Research, Hangzhou, China.
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5
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Yancey AM. Part I: Case series: Pancreatitis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2024; 7:957-970. [DOI: 10.1002/jac5.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 01/03/2025]
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6
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Lin W, Zheng Q, Wang X, Lin X, Ni X, Pan J, Zippi M, Fiorino S, Hong W. The causality between use of glucocorticoids and risk of pancreatitis: a Mendelian randomization study. Front Immunol 2024; 15:1420840. [PMID: 39221257 PMCID: PMC11363070 DOI: 10.3389/fimmu.2024.1420840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND AIM To date, the association between glucocorticoid use and the risk of pancreatitis remains controversial. The aim of this study was the investigation of this possible relationship. METHODS We carried out a two-sample Mendelian randomization (MR) analysis using GWAS data from European ancestry, East Asian descendants and the FinnGen Biobank Consortium to evaluate this potential causal relationship. Genetic variants associated with glucocorticoid use were selected based on genome-wide significance (p < 5×10-8). RESULTS Our MR analysis of European ancestry data revealed no significant causal relationship between glucocorticoid use and AP (IVW: OR=1.084, 95% CI= 0.945-1.242, P=0.249; MR-Egger: OR=1.049, 95% CI= 0.686-1.603, P=0.828; weighted median: OR=1.026, 95% CI= 0.863-1.219, P=0.775) or CP (IVW: OR=1.027, 95% CI= 0.850-1.240, P=0.785; MR-Egger: OR= 1.625, 95% CI= 0.913-2.890, P= 0.111; weighted median: OR= 1.176, 95% CI= 0.909-1.523, P= 0.218). Sensitivity analyses, including MR-Egger and MR-PRESSO, indicated no evidence of pleiotropy or heterogeneity, confirming the robustness of our findings. Multivariable MR analysis adjusted for alcohol consumption, BMI, cholelithiasis and C-reactive protein levels supported these findings. Replicated analysis was performed on datasets from the FinnGen Biobank Consortium and East Asian descendants, and similar results were obtained. CONCLUSIONS This MR analysis suggests that there is no causal association between glucocorticoid use and the risk of pancreatitis.
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Affiliation(s)
- Wenfeng Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiqi Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaorong Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaolu Lin
- Department of Digestive Endoscopy Center, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xixi Ni
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Budrio Hospital, Local Health Unit of Bologna, Bologna, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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7
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Zhou Y, Huang X, Jin Y, Qiu M, Ambe PC, Basharat Z, Hong W. The role of mitochondrial damage-associated molecular patterns in acute pancreatitis. Biomed Pharmacother 2024; 175:116690. [PMID: 38718519 DOI: 10.1016/j.biopha.2024.116690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 06/03/2024] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal tract diseases with significant morbidity and mortality. Current treatments remain unspecific and supportive due to the severity and clinical course of AP, which can fluctuate rapidly and unpredictably. Mitochondria, cellular power plant to produce energy, are involved in a variety of physiological or pathological activities in human body. There is a growing evidence indicating that mitochondria damage-associated molecular patterns (mtDAMPs) play an important role in pathogenesis and progression of AP. With the pro-inflammatory properties, released mtDAMPs may damage pancreatic cells by binding with receptors, activating downstream molecules and releasing inflammatory factors. This review focuses on the possible interaction between AP and mtDAMPs, which include cytochrome c (Cyt c), mitochondrial transcription factor A (TFAM), mitochondrial DNA (mtDNA), cardiolipin (CL), adenosine triphosphate (ATP) and succinate, with focus on experimental research and potential therapeutic targets in clinical practice. Preventing or diminishing the release of mtDAMPs or targeting the mtDAMPs receptors might have a role in AP progression.
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Affiliation(s)
- Yan Zhou
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaoyi Huang
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yinglu Jin
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Minhao Qiu
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Peter C Ambe
- Department of General Surgery, Visceral Surgery and Coloproctology, Vinzenz-Pallotti-Hospital Bensberg, Vinzenz-Pallotti-Str. 20-24, Bensberg 51429, Germany
| | | | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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8
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Khakhar Z, Manji S, Patel RK, Ali SK. Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors and the Risk of Pancreatitis: A Case Report. Cureus 2024; 16:e62957. [PMID: 39044894 PMCID: PMC11265328 DOI: 10.7759/cureus.62957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/25/2024] Open
Abstract
Acute pancreatitis is a condition seldom encountered with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors. They are beneficial in the treatment of various conditions and offer great promise. Despite this, they are associated with several adverse effects, necessitating vigilance and further research. This case study reports a 69-year-old male with multiple comorbidities who presented with epigastric pain radiating to the back. Laboratory tests revealed elevated AST, ALT, GGT and lipase. The patient was diagnosed with acute pancreatitis secondary to the SGLT2 inhibitor therapy regimen. Cessation of dapagliflozin resulted in a complete resolution of symptoms. There is credible evidence to suggest the presence of an association between SGLT2 inhibitors and acute pancreatitis, although extensive research is warranted to consolidate this association.
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Affiliation(s)
| | - Soraiya Manji
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, KEN
| | - Ronak Kumar Patel
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, KEN
| | - Sayed K Ali
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, KEN
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9
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Chahed F, Slim R, Sassi M, Barka M, Ben Sayed N, Fathallah N, Ouni B. Fluoxetine-induced acute pancreatitis: Evidence from a positive re-challenge. Therapie 2024; 79:405-406. [PMID: 37516658 DOI: 10.1016/j.therap.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Ferdaous Chahed
- Pharmacovigilance Center of Sousse, Faculty of Medicine of Sousse. University of Sousse, Tunisia.
| | - Raoudha Slim
- Pharmacovigilance Center of Sousse, Faculty of Medicine of Sousse. University of Sousse, Tunisia
| | - Malek Sassi
- Pharmacovigilance Center of Sousse, Faculty of Medicine of Sousse. University of Sousse, Tunisia
| | - Malek Barka
- Department of Surgery, Farhat Hached hospital Sousse, 4051 Sousse, Tunisia
| | - Nesrine Ben Sayed
- Department of Hematology, Farhat Hached hospital Sousse, 4051 Sousse, Tunisia
| | - Neila Fathallah
- Pharmacovigilance Center of Sousse, Faculty of Medicine of Sousse. University of Sousse, Tunisia
| | - Bouraoui Ouni
- Pharmacovigilance Center of Sousse, Faculty of Medicine of Sousse. University of Sousse, Tunisia
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10
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Fazeli Farsani S, Iglay K, Zhang L, Niyonkuru C, Nessralla L, Girman CJ. Risk of acute pancreatitis among new users of empagliflozin compared to sulfonylureas in patients with type 2 diabetes: A post-authorization safety study. Pharmacoepidemiol Drug Saf 2024; 33:e5800. [PMID: 38719731 DOI: 10.1002/pds.5800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE This study was undertaken to evaluate the potential risk of acute pancreatitis with empagliflozin in patients with type 2 diabetes (T2D) newly initiating empagliflozin. METHODS Data from two large US claims databases were analyzed in an observational study of patients with T2D receiving metformin who were newly prescribed empagliflozin versus sulfonylurea (SU). Because dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists have been associated with the risk of acute pancreatitis in some studies, patients on these agents were excluded. Using pooled analyses of data from the two databases (2014-2021), patients initiating empagliflozin were matched 1:1 within database to patients initiating SU using propensity scores (PS) that incorporated relevant demographic and clinical characteristics. Prespecified sensitivity analyses were performed for design parameters. RESULTS The analyses identified 72 661 new users of empagliflozin and 422 018 new users of SUs, with both patient groups on concurrent metformin therapy. Baseline characteristics within treatment groups appeared to be similar across the 72 621 matched pairs. After mean follow-up of ~6 months, incidence rates of acute pancreatitis in the pooled matched cohort were 10.30 (95% confidence interval [CI] 9.29-11.39) events per 1000 patient-years (PY) for empagliflozin and 11.65 (95% CI 10.59-12.77) events per 1000 PY for SUs. On a background of metformin, patients newly initiating empagliflozin did not have an increased risk of acute pancreatitis compared with those initiating an SU (pooled PS matched hazard ratio 0.88 [0.76-1.02]) across 75621.42 PY of follow-up. CONCLUSIONS The results of this voluntary post-approval safety study provide additional evidence that the use of empagliflozin for the treatment of T2D is not associated with an increased risk of acute pancreatitis.
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Affiliation(s)
| | - Kristy Iglay
- Real World Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA
| | - Ling Zhang
- Global Integrated Evidence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Christian Niyonkuru
- Global Integrated Evidence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Laurieann Nessralla
- Global Patient Safety and Pharmacovigilence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Cynthia J Girman
- Real World Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA
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11
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Li D, Wang H, Qin C, Du D, Wang Y, Du Q, Liu S. Drug-Induced Acute Pancreatitis: A Real-World Pharmacovigilance Study Using the FDA Adverse Event Reporting System Database. Clin Pharmacol Ther 2024; 115:535-544. [PMID: 38069538 DOI: 10.1002/cpt.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/04/2023] [Indexed: 01/04/2024]
Abstract
Timely identification and discontinuation of culprit-drug is the cornerstone of clinical management of drug-induced acute pancreatitis (AP), but the comprehensive landscape of AP culprit-drugs is still lacking. To provide the current overview of AP culprit-drugs to guide clinical practice, we reviewed the adverse event (AE) reports associated with AP in the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database from 2004 to 2022, and summarized a potential AP culprit-drug list and its corresponding AE report quantity proportion. The disproportionality analysis was used to detect adverse drug reaction (ADR) signals for each drug in the drug list, and the ADR signal distribution was integrated to show the risk characteristic of drugs according to the ADR signal detection results. In the FAERS database, a total of 62,206 AE reports were AP-related, in which 1,175 drugs were reported as culprit-drug. On the whole, metformin was the drug with the greatest number of AE reports, followed by quetiapine, liraglutide, exenatide, and sitagliptin. Drugs used in diabetes was the drug class with the greatest number of AE reports, followed by immunosuppressants, psycholeptics, drugs for acid-related disorders, and analgesics. In disproportionality analysis, 595 drugs showed potential AP risk, whereas 580 drugs did not show any positive ADR signal. According to the positive-negative distribution of the ADR signal for drug classes, the drug class with the greatest number of positive drugs was antineoplastic agents. In this study, we provided the current comprehensive landscape of AP culprit-drugs from the pharmacovigilance perspective, which can provide reference information for clinical practice.
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Affiliation(s)
- Dongxuan Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongli Wang
- Department of Pharmacy, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chunmeng Qin
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Dan Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yalan Wang
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Songqing Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Rispoli P, Scandiuzzi Piovesan T, Decorti G, Stocco G, Lucafò M. iPSCs as a groundbreaking tool for the study of adverse drug reactions: A new avenue for personalized therapy. WIREs Mech Dis 2024; 16:e1630. [PMID: 37770042 DOI: 10.1002/wsbm.1630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
Induced pluripotent stem cells (iPSCs), obtained by reprogramming different somatic cell types, represent a promising tool for the study of drug toxicities, especially in the context of personalized medicine. Indeed, these cells retain the same genetic heritage of the donor, allowing the development of personalized models. In addition, they represent a useful tool for the study of adverse drug reactions (ADRs) in special populations, such as pediatric patients, which are often poorly represented in clinical trials due to ethical issues. Particularly, iPSCs can be differentiated into any tissue of the human body, following several protocols which use different stimuli to induce specific differentiation processes. Differentiated cells also maintain the genetic heritage of the donor, and therefore are suitable for personalized pharmacological studies; moreover, iPSC-derived differentiated cells are a valuable tool for the investigation of the mechanisms underlying the physiological differentiation processes. iPSCs-derived organoids represent another important tool for the study of ADRs. Precisely, organoids are in vitro 3D models which better represent the native organ, both from a structural and a functional point of view. Moreover, in the same way as iPSC-derived 2D models, iPSC-derived organoids are appropriate personalized models since they retain the genetic heritage of the donor. In comparison to other in vitro models, iPSC-derived organoids present advantages in terms of versatility, patient-specificity, and ethical issues. This review aims to provide an updated report of the employment of iPSCs, and 2D and 3D models derived from these, for the study of ADRs. This article is categorized under: Cancer > Stem Cells and Development.
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Affiliation(s)
- Paola Rispoli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Giuliana Decorti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Gabriele Stocco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marianna Lucafò
- Department of Life Sciences, University of Trieste, Trieste, Italy
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13
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Inban P, Gulla V, Devani A, Akuma CM, Gowthavaram CA, Hussain A, Aung LLL, Jadav N, Savaliya B, Sajjad T, Khan AM, Akuma O, Kelechi AE. Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report. Clin Case Rep 2023; 11:e8186. [PMID: 38033693 PMCID: PMC10682242 DOI: 10.1002/ccr3.8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/28/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Drug-induced acute pancreatitis is a potentially ignored diagnosis that must be precisely valued. Drug-induced acute pancreatitis can be considered the third common cause of acute pancreatitis after ruling out alcohol and gallstones. Levofloxacin belongs to a class of fluoroquinolone antibiotics used for treating various infections. Besides photosensitivity and liver toxicity, levofloxacin can induce acute pancreatitis, although rarely described. We highlight a case of acute pancreatitis in a female induced by levofloxacin. She presented with typical signs and symptoms of acute pancreatitis and had been taking levofloxacin for urinary tract infections for the last 3 days. After ruling out all other possible causes, her clinical picture, laboratory results, and imaging findings confirmed acute pancreatitis induced by levofloxacin.
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Affiliation(s)
- Pugazhendi Inban
- Department of General MedicineGovernment Medical College, OmandurarChennaiIndia
| | - Virali Gulla
- Internal MedicineSri Padmavathi Medical College, SVIMSTirupatiIndia
| | - Aarfa Devani
- Department of Internal MedicineMalla Reddy Institute of Medical SciencesHyderabadIndia
| | | | | | - Akbar Hussain
- Internal MedicineJinnah Sindh Medical UniversityKarachi CitySindhPakistan
| | | | - Neel Jadav
- Internal MedicinePramukh Swami Medical CollegeValsadIndia
| | | | - Taha Sajjad
- Medical EducationMount Vista Medical CentrePHOENIXArizonaUSA
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Fang C, Xie Y, Mai H, Xu L. Acute abdominal pain as the first symptom of Chlamydia psittaci pneumonia complicated by acute pancreatitis: a case report. Front Med (Lausanne) 2023; 10:1253859. [PMID: 37886359 PMCID: PMC10598660 DOI: 10.3389/fmed.2023.1253859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Background Chlamydia psittaci infections primarily cause damage to the lungs but may also affect the cardiovascular system, gastrointestinal tract, liver, kidney, and brain, resulting in a variety of extrapulmonary complications. However, reports regarding C. psittaci infection-associated pancreatitis are rare. In this report, a patient with C. psittaci pneumonia complicated by acute pancreatitis is presented. Case description The patient presented with acute upper abdominal pain and developed severe pyrexia and dyspnoea one day later. A chest computed tomography image revealed patchy consolidation in the left lung. The disease progressed rapidly, and the patient exhibited liver and kidney damage and type 1 respiratory failure within a short period of time. Metagenomic next-generation sequencing of alveolar lavage fluid revealed the presence of C. psittaci. The patient was administered doxycycline and moxifloxacin, after which the patient's abdominal pain and lung infection significantly resolved. Conclusion This case report demonstrates that extrapulmonary C. psittaci infections due to secondary acute pancreatitis can manifest as abdominal pain, although the exact mechanisms of C. psittaci caused by acute pancreatitis remain unclear. Timely diagnoses and treatments of such infections are necessary to achieve favorable clinical outcomes.
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Affiliation(s)
- Changquan Fang
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Yanjun Xie
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Hui Mai
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, Guangdong, China
| | - Limin Xu
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, Guangdong, China
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15
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Maringanti BS, Ganipisetti VM, Jun SS, Flores MI. Tigecycline Tango: A Case of Antibiotic-Induced Pancreatitis. Cureus 2023; 15:e44538. [PMID: 37790018 PMCID: PMC10544690 DOI: 10.7759/cureus.44538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Acute pancreatitis is a frequent cause of hospitalization, with the most common triggers being alcohol consumption and gallstones. Although the incidence of drug-induced pancreatitis remains low, it is steadily increasing due to the advent of newly discovered broad-spectrum antibiotics targeting multi-drug resistant organisms. Tigecycline, a broad-spectrum intravenous antibiotic derived from the tetracycline class, was approved by the FDA in 2005 for the treatment of complicated skin and skin structure infections, complicated intra-abdominal infections, and community-acquired pneumonia. It has activity against vancomycin-resistant Enterococcus, Methicillin-resistant Staphylococcus aureus, multi-drug-resistant Acinetobacter baumannii, multi-drug-resistant Stenotrophomonas maltophilia, and Extended Spectrum Beta-lactamase (ESBL) producing Enterobacter species. However, it was later discovered that tigecycline can cause acute pancreatitis. We present a case of a 27-year-old female patient who was admitted to the emergency department with abdominal pain and was subsequently diagnosed with tigecycline-induced pancreatitis based on the clinical resolution after withdrawal of the drug.
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Affiliation(s)
| | | | - Scott S Jun
- Internal Medicine, University of New Mexico, Albuquerque, USA
| | - Mario I Flores
- Internal Medicine, University of New Mexico, Albuquerque, USA
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16
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Tan Q, Zhang Y, Liu M, Tian D, Wu X, Zhou L, Fan W. Clinical characteristics and risk factors for tigecycline-induced pancreatitis in a tertiary hospital: A retrospective study. Br J Clin Pharmacol 2023; 89:2788-2797. [PMID: 37161703 DOI: 10.1111/bcp.15776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS To analyse the clinical characteristics and risk factors for tigecycline-induced pancreatitis (TIP) and evaluate the safety and efficiency of tigecycline use in non-TIP. METHODS A retrospective case-control study was conducted on adult and juvenile patients administered tigecycline for >3 days. The adults were classified as TIP, non-TIP (pancreatitis with other causes) and non-pancreatitis. Univariate analyses were performed to compare TIP and non-pancreatitis, and multivariate analysis was used to identify risk factors for TIP. The clinical characteristics of TIP, and the safety and efficiency of tigecycline use in non-TIP were evaluated. RESULTS A total of 3910 patients (3823 adults and 87 juveniles) were enrolled. The adult patients comprised 21 TIP, 82 non-TIP and 3720 non-pancreatitis. The TIP prevalence was 0.56% in adults and 1.15% in juveniles. The mean time from tigecycline use to symptom onset was 7.2 days, and all cases were mild pancreatitis. The mean time from tigecycline withdrawal to symptom relief was 3.6 days. The multivariate analysis identified comorbid renal insufficiency as an independent risk factor for TIP (odds ratio = 3.032). Among the 82 non-TIP patients, 81.7% had severe pancreatitis and 47.6% had necrotizing pancreatitis. The modified computed tomography severity score after tigecycline use was similar to that before tigecycline use, but the pancreatic enzymes and infection indices were significantly decreased. CONCLUSIONS The prevalence of TIP was low. Comorbid renal insufficiency was as an independent risk factor for TIP. Tigecycline is safe and efficient for treatment of pancreatitis, especially necrotizing pancreatitis, with intra-abdominal infection.
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Affiliation(s)
- Qinghai Tan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - De'an Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohui Wu
- Department of Internal Medicine, Dangyang Changbanpo Hospital, Yichang, Hubei, China
| | - Lei Zhou
- Department of Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjuan Fan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Wuhan, Hubei, China
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17
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Omoregie O, Ugwuoke UT, Agho O, Okonna UC, Iklaki WU, Okoro GC. A Rare Case of Levofloxacin-Induced Acute Pancreatitis: Case Report and Literature Review. Cureus 2023; 15:e42743. [PMID: 37654929 PMCID: PMC10467605 DOI: 10.7759/cureus.42743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Diagnosing acute pancreatitis induced by any drug is often overlooked and warrants careful evaluation. Drug-induced acute pancreatitis is relatively rare, and diagnosis of exclusion after ruling out alcohol, gallstones, hypertriglyceridemia, and intervention. Levofloxacin, a class of fluoroquinolones, is generally recommended against various bacterial infections. While levofloxacin is mainly known for its potential side effects, such as photosensitivity and liver toxicity, it can also rarely induce acute pancreatitis. We report a case of acute pancreatitis in a female patient precipitated by levofloxacin. The patient exhibited typical manifestations of acute pancreatitis and had been taking levofloxacin for a urinary tract infection over the past three days. After ruling out other possible causes, her clinical presentation, laboratory results, and imaging findings confirmed levofloxacin-induced acute pancreatitis.
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Affiliation(s)
- Osahon Omoregie
- Family and Community Medicine, National Health Service, Glasgow, GBR
| | - Uyonne T Ugwuoke
- Public Health, East Tennessee State University, Johnson City, USA
| | - Osamede Agho
- Internal Medicine, Internal Medicine Solutions, New York, USA
- Internal Medicine, Igbinedion University Medical School, Benin, NGA
| | | | - Winifred U Iklaki
- Internal Medicine, All Saints University, School of Medicine, Roseau, DMA
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18
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Jasti VV, McCarthy ST, Govani SM. Dupilumab-Induced Pancreatitis. ACG Case Rep J 2023; 10:e01106. [PMID: 37492485 PMCID: PMC10365188 DOI: 10.14309/crj.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/08/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
Drug-induced pancreatitis (DIP) is a rare cause of pancreatitis with an extensive and growing list of offending medications. Drawing a causative relationship between a medication and pancreatitis can be challenging, requiring a thorough workup to exclude other potential etiologies. By using scoring systems to identify DIP, we have identified another case of suspected DIP. In this study, we present a case of pancreatitis 10 days after initiation of dupilumab. An evaluation for other causes was unrevealing. As dupilumab use increases, providers should be aware of this possible adverse effect.
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Affiliation(s)
- Vivek V. Jasti
- Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, OH
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Abstract
OBJECTIVE Antidepressant-induced pancreatitis is a rare, albeit serious, adverse effect, with a frequency of occurrence that is not equally distributed among antidepressant drugs. The goal of this study was to investigate the association and causal relationship between mirtazapine treatment of patients with depression and pancreatitis. METHODS The study was designed as a systematic review of the literature, accompanied by the description of a new case of mirtazapine-associated acute pancreatitis. RESULTS Nine cases of mirtazapine-associated pancreatitis have been reported, involving 7 female patients and 2 male patients with a mean age of 46.4 years (range: 26 to 83 y of age). All of the patients were hospitalized, with an average length of stay of 16.2 days (range: 3 to 34 d). In 6 cases, "de-challenge" followed by improvement was reported. The patients for whom the outcome was reported (7 of 9) recovered completely. CONCLUSION Although a rare adverse effect, mirtazapine-induced pancreatitis should be considered when patients taking mirtazapine report abdominal discomfort.
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20
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Goraya MHN, Abbasi EUH, Amin MK, Inayat F, Ashraf MJ, Qayyum M, Hussain N, Nawaz G, Zaman MA, Malik A. Acute pancreatitis secondary to tamoxifen-associated hypertriglyceridemia: A clinical update. J Oncol Pharm Pract 2023; 29:218-225. [PMID: 35410558 DOI: 10.1177/10781552221093969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Drug-induced pancreatitis has been increasingly recognized, but it is frequently encountered as an inconspicuous etiology. The underlying mechanisms of injury vary with different drugs. Tamoxifen is a frequently used anticancer drug that acts by selective modulation of the estrogen receptor in patients with breast cancer. Tamoxifen-induced hypertriglyceridemia is a relatively rare etiological factor for acute pancreatitis. However, acute pancreatitis secondary to this adverse effect remains an exceedingly important clinicopathologic entity. CASE REPORT We hereby delineate a rare case of acute pancreatitis secondary to hypertriglyceridemia in a patient who was on tamoxifen treatment for the past 3 years. Her serum lipase and triglyceride levels were markedly elevated at 14,285 IU/L and 20,344 mg/dL, respectively. The diagnosis was considered based on the findings of a standard diagnostic workup and exclusion of alternative causes of acute pancreatitis. MANAGEMENT AND OUTCOME The patient was instituted prompt treatment with intravenous insulin infusion and gemfibrozil. The clinical outcome was favorable with no complications. Tamoxifen was permanently discontinued and was replaced with letrozole. DISCUSSION This article illustrates that acute pancreatitis should be considered in the differential diagnoses of abdominal pain and elevated pancreatic enzymes in patients undergoing tamoxifen treatment. It also underscores the importance of pre- and post-tamoxifen lipid screening, especially in patients with a history of dyslipidemia and diabetes mellitus. It will facilitate an expedient detection of hypertriglyceridemia, potentially saving patients from associated morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | - Gul Nawaz
- 66909Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Adnan Malik
- 25815Loyola University Medical Center, Maywood, IL, USA
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21
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He S, Ikner TP, Taylor BV, Aguiar T, Thakur NP, Chakravorty S. Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders. J Natl Med Assoc 2022; 114:617-620. [PMID: 36114064 DOI: 10.1016/j.jnma.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.
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Affiliation(s)
- Sean He
- Saint Louis University School of Medicine, Saint Louis, MO 63104, USA.
| | - Taylor P Ikner
- University of Pennsylvania College of Liberal and Professional Studies, USA
| | | | - Taylor Aguiar
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Nina P Thakur
- University of New England College of Osteopathic Medicine, Biddleford, ME 04005, USA
| | - Subhajit Chakravorty
- Cpl. Michael J Crescenz VA Medical Center, Philadelphia, PA 19104, USA; Perelman School of Medicine, Philadelphia, PA 19104, USA
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22
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Zhang L, Mao W, Li X, Wang X, Liu J, Hu S, Hu J. Analysis of acute pancreatitis associated with SGLT-2 inhibitors and predictive factors of the death risk: Based on food and drug administration adverse event report system database. Front Pharmacol 2022; 13:977582. [PMID: 36467046 PMCID: PMC9716078 DOI: 10.3389/fphar.2022.977582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/31/2022] [Indexed: 08/24/2023] Open
Abstract
Background and objectives: The US FDA and Health Canada have successively published potential red flags for acute pancreatitis caused by sodium-dependent glucose transporter 2 inhibitors (SGLT-2i). However, existing studies have focused on case reports. We aimed to assess the possible association of SGLT-2i with acute pancreatitis by analyzing postmarketing adverse events reported in the FDA adverse event reporting system (FAERS), to explore risk factors for SGLT-2i-related acute pancreatitis death, and to build a nomogram. Methods and Results: We used a disproportionality analysis of suspected acute pancreatitis-related reports in the FAERS database of patients from the use of SGLT-2i from the first quarter of 2013 to the fourth quarter of 2021. Single-factor and multi-factor logistic regression analyses were performed using the relevant clinical information of patients, and risk factors were combined with the age of patients to construct a SGLT-2i risk prediction model for acute pancreatitis-related death. A total of 757 reports were retrieved. The largest number of acute pancreatitis-related cases were caused by canagliflozin (317 reports), which was also the strongest agent associated with acute pancreatitis, with the information component (IC 2.41, lower 95% one-sided confidence interval 2.16), the reporting odds ratio (ROR 5.37, 95% two-sided confidence interval 4.8-5.99), and the empirical Bayesian geometric mean (EBGM 5.32, lower 90% one-sided confidence interval 4.85). The median time to acute pancreatitis was 54 (interquartile range [IQR] 14-131) days, and approximately 83% of adverse events occurred within 6 months. Odds ratio(OR) adjusted by acute pancreatitis and the coadministration of SGLT-2i with dipeptidyl peptidase 4 inhibitor (DPP-4i), glucagon-like peptide 1 analog (GLP-1RA), and angiotensin converting enzyme inhibitor (ACEIs) was 1.39, 1.97, and 1.34, respectively, all of which were statistically significant. Logistic regression analysis showed that different SGLT-2i type and their combinations with statins were independent risk factors for acute pancreatitis mortality in the patients (p < 0.05). The mortality risk prediction model showed good discrimination and clinical applicability in both the training set (AUC 0.708) and the validation set (AUC 0.732). Conclusion: SGLT-2i may increase the risk of acute pancreatitis especially within the first 6 months of drug administration. Combination with DPP-4i, GLP-1RA or ACEIs significantly increases the risk of acute pancreatitis. In addition, different SGLT-2i type and their combination with statins are risk factors that can predict the risk of death following acute pancreatitis.
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Affiliation(s)
- Lin Zhang
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Mao
- Department of Pharmacy, Nanan People’s Hospital of Chongqing, Chongqing, China
| | - Xingxing Li
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaowen Wang
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jifang Liu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Sang Hu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Hu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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23
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The Pancreas and Known Factors of Acute Pancreatitis. J Clin Med 2022; 11:jcm11195565. [PMID: 36233433 PMCID: PMC9571992 DOI: 10.3390/jcm11195565] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatitis is regarded by clinicians as one of the most complicated and clinically challenging of all disorders affecting the abdomen. It is classified on the basis of clinical, morphological, and histological criteria. Causes of acute pancreatitis can easily be identified in 75–85% of patients. The main causes of acute, recurrent acute, and chronic pancreatitis are gallstone migration and alcohol abuse. Other causes are uncommon, controversial, or unexplained. For instance, cofactors of all forms of pancreatitis are pancreas divisum and hypertriglyceridemia. Another factor that should be considered is a complication of endoscopic retrograde cholangiopancreatography: post-endoscopic retrograde cholangiopancreatography acute pancreatitis. The aim of this study is to present the known risk factors for acute pancreatitis, beginning with an account of the morphology, physiology, and development of the pancreas.
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Vara-Luiz F, Pé D’Arca Barbosa F, Antunes Albuquerque A, Valada Marques A, Spencer V. An Uncommon Cause of Acute Pancreatitis in a Patient With COVID-19. Cureus 2022; 14:e27910. [PMID: 36110472 PMCID: PMC9464349 DOI: 10.7759/cureus.27910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 12/15/2022] Open
Abstract
Drug-induced pancreatitis is a rare though important condition that remains a diagnostic challenge. Most of the evidence relies on case reports, and clinicians should consider a high suspicion of the diagnosis after ruling out other causes. In particular, steroids are frequently used drugs that have recently been associated with acute pancreatitis. The authors present the case of a 60-year-old female admitted to the emergency room with a fever and shortness of breath. The SARS-CoV-2 test was positive, and the chest radiography was suggestive of COVID-19 pneumonia. The patient started dexamethasone because of respiratory failure. On Day 7, she developed epigastric pain radiating to the back and the amylase level was greater than 10 times the upper reference limit (1354 U/L). A detailed evaluation of the medical history, along with the exclusion of other possible etiologies confirmed the diagnosis of steroid-induced pancreatitis. Supportive care and cessation of the offending drug led to the resolution of symptoms. As steroids are used as part of the treatment of most COVID-19 patients, this case suggests the need to consider this entity, as a delay in the diagnosis may result in complications and prolonged hospital stay.
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Bath H, Jawandha K, Elhassan MG. Hydroxyurea-Induced Acute Pancreatitis. Cureus 2022; 14:e26132. [PMID: 35891817 PMCID: PMC9302551 DOI: 10.7759/cureus.26132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Drug-induced pancreatitis (DIP), while not a major cause of acute pancreatitis, remains a debilitating diagnosis resulting in significant patient morbidity and mortality. The diagnosis includes first diagnosing acute pancreatitis, second ruling out more common etiologies (alcohol abuse, gallstones, etc.), and third documenting a thorough history (in particular medications). Essentially, it is a diagnosis of exclusion. Any drugs with the potential to result in acute pancreatitis should be discontinued, and those without future recurrence of pancreatitis are deemed to have had a drug-induced case. Although the exact pathophysiology of the initial development of DIP is unknown, we hypothesize it is different for various drug classes. It is known that once pancreatic enzymes are activated after insult, they activate an inflammatory response resulting in auto-digestion of the pancreas. Our report discusses a previously not documented case of DIP in a patient on hydroxyurea monotherapy for the treatment of Janus kinase 2 (JAK2) essential thrombocytosis.
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26
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Safizadeh Shabestari SA, Ho SB, Chaudhary P, Nathwani RA. Drug-induced acute pancreatitis in a bodybuilder: a case report. J Med Case Rep 2022; 16:114. [PMID: 35313971 PMCID: PMC8939103 DOI: 10.1186/s13256-022-03329-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Background Unregulated use of a variety of drugs and supplements by bodybuilders and athletes is common and can lead to severe adverse complications. Only a small proportion of acute pancreatitis cases are drug induced, and case reports are essential for identifying potential drug-related risks for pancreatitis. Here we present the first case report published of acute pancreatitis linked to recreational use of anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol in a previously healthy male after excluding all other causes of pancreatitis. Case presentation A 31-year-old Arab male bodybuilder presented with acute abdominal pain associated with nausea and sharp pain radiating to the back. The patient was not using tobacco or alcohol but was using multiple drugs related to bodybuilding, including anabolic–androgenic steroids, subcutaneous growth hormone, clenbuterol, and multiple vitamin supplements. Laboratory studies revealed a normal white blood cell count, elevated C-reactive protein, minimally elevated aspartate aminotransferase and total bilirubin with normal remaining liver tests, and elevated amylase and lipase. The patient had no hypertriglyceridemia or hypercalcemia, and had had no recent infections, abdominal procedures, trauma, or scorpion exposure. Imaging and laboratory investigations were negative for biliary disease and IgG4 disease. Abdominal computed tomography revealed hepatomegaly and diffuse thickening and edema of the body and tail of the pancreas with peripancreatic fat stranding. An abdominal ultrasound showed slight hepatomegaly with no evidence of cholelithiasis. Genetic testing for hereditary pancreatitis-related mutations was negative. A diagnosis of drug-induced acute pancreatitis was made, and he was treated with aggressive intravenous hydration and pain management. The patient has avoided further use of these drugs and supplements and had no further episodes of pancreatitis during 1 year of follow-up. Conclusions This case describes a patient with drug-induced acute pancreatitis after the intake of anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol, where all other common causes of acute pancreatitis were excluded. Clinicians should be alert to the possibility of drug-induced acute pancreatitis occurring in bodybuilders and athletes using similar drug combinations.
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Affiliation(s)
- Seyed Ali Safizadeh Shabestari
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Building 14, 505055, Dubai, United Arab Emirates
| | - Samuel B Ho
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Building 14, 505055, Dubai, United Arab Emirates.,Department of Gastroenterology, Mediclinic City Hospital, North Wing Clinic, Dubai Healthcare City, Building 35, 505004, Dubai, United Arab Emirates
| | - Priyadarshini Chaudhary
- Department of Radiology, Mediclinic City Hospital, Dubai Healthcare City, Building 31, 505004, Dubai, United Arab Emirates
| | - Rahul A Nathwani
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Building 14, 505055, Dubai, United Arab Emirates. .,Department of Gastroenterology, Mediclinic City Hospital, North Wing Clinic, Dubai Healthcare City, Building 35, 505004, Dubai, United Arab Emirates.
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27
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Grover S, Sarkar S, Avasthi A. Management of Systemic Medical Emergencies Associated with Psychotropic Medications. Indian J Psychiatry 2022; 64:S252-S280. [PMID: 35602374 PMCID: PMC9122155 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1014_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Ajit Avasthi
- Consultant Psychiatrist, Fortis Hospital, Mohali and Chhuttani Medical Centre, Chandigarh, India
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Cannabinoid-Related Acute Pancreatitis: An Update from International Literature and Individual Case Safety Reports. Drug Saf 2022; 45:215-235. [PMID: 35179705 DOI: 10.1007/s40264-022-01146-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In addition to the growing interest of different cannabinoids for therapeutic purposes, the safety profile of these substances has changed, with the recent identification of new events such as acute pancreatitis. OBJECTIVE The aim of this study was to characterize cannabinoid-related acute pancreatitis, based on the recent literature and the analysis of pharmacovigilance data available worldwide. METHODS Nine national and international pharmacovigilance databases were requested for individual case safety reports of acute pancreatitis related to cannabinoid exposure. A systematic review was performed searching in PubMed®, Web of Science®, and Google Scholar® for any publication dealing with acute pancreatitis and cannabinoid exposure (cannabis, cannabinoid, cannabidiol, tetrahydrocannabinol, nabilone, dronabinol), to identify case reports, observational studies, clinical trials, or reviews. All queries were updated on 1 January, 2021. RESULTS Twenty-two individual case safety reports were identified in the pharmacovigilance databases and 51 in the literature, corresponding to a predominantly young male population (74% of men, median age 28 interquartile range [21-39]) using recreational Cannabis sativa with high intensity. A therapeutic purpose was identified in 13 cases (including tetrahydrocannabinol, cannabidiol, and dronabinol). The outcome was often favorable after dechallenge (except three deaths), and frequent recurrences were observed in the case of rechallenge or sustained consumption. Eleven cross-sectional studies and one ecological study showed an increasing trend of cannabis use in in-patients with acute pancreatitis, with a significantly lower in-hospital mortality. CONCLUSIONS This review underlines that acute pancreatitis is a potential adverse effect of cannabinoid use. It remains often unrecognized and can occur during recreational or therapeutic use. The development of the therapeutic use of cannabinoids in frail patients deserves a better investigation of the benefit-risk ratio of these different products.
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Iqbal K, Rathore SS, Hanyalu Shankar V, Deepika K, Pattan V, Koritala T, Jain N, Adhikari R. A Case of Acute Pancreatitis in a Patient Receiving High-Dose Steroids for Optic Neuritis. Cureus 2021; 13:e19132. [PMID: 34858765 PMCID: PMC8614170 DOI: 10.7759/cureus.19132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
Although rare, drug-induced pancreatitis is an important cause of acute pancreatitis. The diagnosis of drug-induced pancreatitis remains a challenge for clinicians. Steroids are one of the frequently used drugs in hospitals for many acute illnesses. Patients presenting with signs and symptoms of acute pancreatitis, with a recent history of steroid use, in the absence of other potential causes, should be approached with a high suspicion for steroid-induced pancreatitis to ensure a timely diagnosis. We describe a case of a 57-year-old female treated for optic neuritis of the left eye with high doses of Methylprednisolone for five days, who presented to the emergency room with acute abdominal pain within 24 hours of discharge. A detailed evaluation of the patient's medical history and exclusion of other probable etiologies confirmed the diagnosis of steroid-induced pancreatitis. Withdrawal of the offending agent and supportive care resolved the underlying acute pancreatitis.
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Affiliation(s)
- Kinza Iqbal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Keerti Deepika
- Pediatrics/Translational Research, Thomas Jefferson University, Philadelphia, USA
| | | | | | - Nitesh Jain
- Pulmonary and Critical Care Medicine, Mayo Clinic, Mankato, USA
| | - Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
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Shelat VG. Sulfasalazine induced acute pancreatitis in a patient with prior cholecystectomy. Postgrad Med J 2021; 97:738-739. [PMID: 32848081 DOI: 10.1136/postgradmedj-2020-138648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Vishal G Shelat
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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31
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Goyal P, Moyers JT, Elgohary BG, Hammami MB. Case Report: Nivolumab-Induced Autoimmune Pancreatitis. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:208-211. [PMID: 35665025 PMCID: PMC9138477 DOI: 10.36401/jipo-21-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/09/2022]
Abstract
Nivolumab is an anti-programmed cell death protein 1 monoclonal antibody. While an effective treatment for a variety of tumors, immune checkpoint inhibitors (ICI) can cause immune-related adverse events such as ICI-pancreatic injury (ICI-PI). Here we present a case of a 60-year-old man with metastatic acral melanoma treated with nivolumab and ipilimumab who developed ICI-PI. Changes in positron emission tomography images preceded symptom onset. However, this case is unique in that the patient presented with cholestatic liver disease. Magnetic resonance cholangiopancreatography showed a dilated extrahepatic bile duct that resolved with steroid therapy, similar to the clinical course of autoimmune pancreatitis. ICI-PI has variable presentations including obstructive jaundice with a clinical course mimicking autoimmune pancreatitis and prompt awareness and treatment of ICI-PI is clinically significant given increasing use of ICIs.
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Affiliation(s)
- Preeya Goyal
- Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, USA
- Department of Internal Medicine, Division of Gastroenterology, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA
| | - Justin T. Moyers
- Department of Internal Medicine, Division of Gastroenterology, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA
- Department of Internal Medicine, Division of Hematology and Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Bassem G. Elgohary
- Department of Internal Medicine, Division of Gastroenterology, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA
| | - Muhammad B. Hammami
- Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, USA
- Department of Internal Medicine, Division of Gastroenterology, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA
- University of California, Riverside, Riverside, CA, USA
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32
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Aziz M, Ahmed Z, Weissman S, Ghazaleh S, Beran A, Kamal F, Lee-Smith W, Assaly R, Nawras A, Pandol SJ, McDonough S, Adler DG. Lactated Ringer's vs normal saline for acute pancreatitis: An updated systematic review and meta-analysis. Pancreatology 2021; 21:1217-1223. [PMID: 34172360 DOI: 10.1016/j.pan.2021.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recent studies have evaluated and compared the efficacy of normal saline (NS) and lactated Ringer's (LR) in reducing the severity of acute pancreatitis (AP) and improving outcomes such as length of stay, the occurrence of the systemic inflammatory response syndrome (SIRS), ICU admission and mortality. We performed an updated systematic review and meta-analysis of the available studies to assess the impact of these fluids on outcomes secondary to AP. METHODS We systematically searched the following databases: PubMed/Medline, Embase, Cochrane, and Web of Science through February 8th, 2021 to include randomized controlled trials (RCTs) and cohort studies. Random effects model using DerSimonian-Laird approach was employed and risk ratios (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated for binary and continuous outcomes, respectively. RESULTS 6 studies (4 RCTs and 2 cohort studies) with 549 (230 in LR and 319 in NS) were included. The overall mortality (RR: 0.73, CI: 0.31-1.69) and SIRS at 24 h (RR: 0.69, CI: 0.32-1.51) was not significantly different. The overall ICU admission was lower in LR group compared to NS group (RR: 0.43, CI: 0.22-0.84). Subgroup analysis of RCTs demonstrated lower length of hospital stay for LR group compared to NS group (MD: 0.77 days, CI: 1.44 -0.09 days). CONCLUSION Our study demonstrated that LR improved outcomes (ICU admission and length of stay) in patients with AP compared to NS. There was no difference in rate of SIRS development and mortality between LR and NS treatments.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA.
| | - Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack University - Palisades Medical Center, North Bergen, NJ, USA
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Faisal Kamal
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Stephen J Pandol
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, UT, USA.
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Kamath A, Acharya SD, Rao RR, Ullal SD. Assessment of pancreatitis associated with tocilizumab use using the United States Food and Drug Administration Adverse Event Reporting System database. Sci Rep 2021; 11:18818. [PMID: 34552181 PMCID: PMC8458491 DOI: 10.1038/s41598-021-98325-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
Tocilizumab (TCZ) is used to treat rheumatoid arthritis and other systemic inflammatory disorders. There is some evidence suggesting the occurrence of pancreatitis following TCZ use. We aimed to determine the reporting of pancreatitis following TCZ use in comparison with other drugs using the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. We extracted adverse event reports submitted to FAERS during 2013-2019. A reporting odds ratio (ROR) with the lower bound 95% confidence interval (CI) > 1 and a lower limit of a two-sided 95% interval of information component (IC025) more than zero was considered significant. Following deduplication, 3,383,910 adverse event reports were available; 144 (0.004%) reports were of pancreatic adverse events associated with TCZ use, and 15,907 (0.47%) associated with other drugs. Of the 144 cases, 74 (51.39%) received concomitant medications with pancreatotoxic potential. The likelihood of reporting of pancreatic events, compared with any other adverse event, with TCZ use was 1.32 times higher than that with other drugs. The lower bound of the 95% CI of the ROR and IC remained above the criteria of significance throughout the study period, except 2013. The findings suggest disproportionately high reporting of pancreatitis in patients receiving TCZ as compared with other drugs. This marginally high reporting is not likely to be of immediate clinical concern and needs to be interpreted cautiously.
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Affiliation(s)
- Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Sahana D Acharya
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Rashmi R Rao
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sheetal D Ullal
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Genova E, Stocco G, Decorti G. Induced pluripotent stem cells as an innovative model to study drug induced pancreatitis. World J Gastroenterol 2021; 27:5796-5802. [PMID: 34629803 PMCID: PMC8475012 DOI: 10.3748/wjg.v27.i35.5796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/27/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-induced pancreatitis is a gastrointestinal adverse effect concerning about 2% of drugs. The majority of cases are mild to moderate but severe episodes can also occur, leading to hospitalization or even death. Unfortunately, the mechanisms of this adverse reaction are still not clear, hindering its prevention, and the majority of data available of this potentially life-threatening adverse effect are limited to case reports leading to a probable underestimation of this event. In particular, in this editorial, special attention is given to thiopurine-induced pancreatitis (TIP), an idiosyncratic adverse reaction affecting around 5% of inflammatory bowel disease (IBD) patients taking thiopurines as immunosuppressants, with a higher incidence in the pediatric population. Validated biomarkers are not available to assist clinicians in the prevention of TIP, also because of the inaccessibility of the pancreatic tissue, which limits the possibility to perform dedicated cellular and molecular studies. In this regard, induced pluripotent stem cells (iPSCs) and the exocrine pancreatic differentiated counterpart could be a great tool to investigate the cellular and molecular mechanisms underlying the development of this undesirable event. This particular type of stem cells is obtained by reprogramming adult cells, including fibroblasts and leukocytes, with a set of transcription factors known as the Yamanaka's factors. Maintaining unaltered the donors' genetic heritage, iPSCs represent an innovative model to study the mechanisms of adverse drug reactions in individual patients' tissues not easily obtainable from human probands. Indeed, iPSCs can differentiate under adequate stimuli into almost any somatic lineage, opening a new world of opportunities for researchers. Several works are already available in the literature studying liver, central nervous system and cardiac cells derived from iPSCs and adverse drug effects. However, to our knowledge no studies have been performed on exocrine pancreas differentiated from iPSCs and drug-induced pancreatitis, so far. Hence, in this editorial we focus specifically on the description of the study of the mechanisms of TIP by using IBD patient-specific iPSCs and exocrine pancreatic differentiated cells as innovative in vitro models.
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Affiliation(s)
- Elena Genova
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste 34127, Italy
| | - Giuliana Decorti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste 34137, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste 34127, Italy
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35
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Sly M, Clark K, Karaghossian G, Narang VK, Gill M, Ragland AS. Cannabis-Induced Pancreatitis in a Young Adult Male. J Investig Med High Impact Case Rep 2021; 9:23247096211035238. [PMID: 34293944 PMCID: PMC8312169 DOI: 10.1177/23247096211035238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drugs account for 2% of all the causes of acute pancreatitis. To date, there are approximately 26 reported cases of acute pancreatitis associated with the use of cannabis. We report the case of a 20-year-old male who presented with intractable nausea, vomiting, and epigastric pain and a lipase level of 1541 with reportedly no alcohol use, and no evidence of medication, biliary, or autoimmune etiology. However, the patient did endorse heavily smoking cannabis prior to symptom onset. He was instructed to abstain from cannabis use on discharge and has not presented to the hospital since this episode. The reporting of this case aims to increase awareness of cannabis as a differential diagnosis in cases of pancreatitis that is not due to typical etiologies such as gallstones, medications, and alcohol use. There has yet to be definitive evidence as to how cannabis can cause pancreatitis. Further studies must be conducted to better understand the association between cannabis use and acute pancreatitis and the mechanism by which cannabis affects the pancreas.
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Affiliation(s)
| | | | | | | | | | - Alan Scott Ragland
- Kern Medical, Bakersfield, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
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36
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Song QL, Guan Y. A case of acute pancreatitis induced by voriconazole during treatment of cryptococcal meningitis. Br J Clin Pharmacol 2021; 88:1925-1929. [PMID: 34214221 DOI: 10.1111/bcp.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
Abstract
Acute pancreatitis refers to pancreatic enzyme activation caused by a variety of aetiologies, and mainly characterized by local inflammation of the pancreas, with or without diseases of other organ function changes. The main clinical features are abdominal pain and elevated trypsin levels in the blood. Common causes of acute pancreatitis include cholelithiasis, alcohol consumption and hyperlipidaemia, among which drugs are considered to be one of the rare causes of pancreatitis. The patient in this case was a 16-year-old adolescent female who developed acute severe pancreatitis during the treatment of cryptococcal meningitis with voriconazole for 35 days. Following diagnosis that pancreatitis was induced by voriconazole, the drug was immediately stopped and the patient was discharged after symptomatic treatment. The phenomenon of voriconazole-induced pancreatitis is extremely rare, but we hope that this report can arouse greater attention and vigilance of the majority of medical personnel to improve the safety of patients' medication, especially for children or minors.
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Affiliation(s)
- Qun Li Song
- Department of Clinical Pharmacy, People's Hospital of Tongchuan, Tongchuan, China.,Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yue Guan
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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37
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Posttraumatic Pancreatitis Four Days after Renal Injury with Massive Retroperitoneal Hematoma. Case Rep Emerg Med 2021; 2021:6693259. [PMID: 34040811 PMCID: PMC8121604 DOI: 10.1155/2021/6693259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
A 25-year-old man accidentally fell from a cliff and hit his right flank on the ground while camping. Initially, he was able to barely walk, but he ultimately became unable to walk at all due to severe flank pain. He had no remarkable personal or family history and was a social drinker. Upon arrival, he showed clear consciousness but was in a hemorrhagic shock state. Enhanced computed tomography (CT) revealed extravasation of contrast medium from the injured right kidney with massive retroperitoneal hematoma. He underwent massive blood transfusion and tracheal intubation followed by renal embolization. His vital signs stabilized on hospital day 2, and he was extubated on day 3. On days 4 and 5, a blood examination revealed increased levels of amylase (360 and 904 IU/L, respectively). Enhanced CT on day 5 did not show signs of severe acute pancreatitis. The maximum amylase level was 1041 IU/L on day 6 and decreased day by day without deterioration of the severity of his acute pancreatitis. He was discharged on day 14. The subacute phase of posttraumatic acute pancreatitis in the present case may have been induced not by direct injury to the pancreas but by several causative factors, such as shock, increased pressure of the retroperitoneal space, or the release of inflammatory mediators from injured tissues or hematoma.
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38
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Wilson A, Wang Q, Choi YH, Ponich T, Gregor JC, Chande N, Yan B, Sey M, Beaton M, Kim RB. Pretreatment HLADQA1-HLADRB1 Testing for the Prevention of Azathioprine-Induced Pancreatitis in Inflammatory Bowel Disease: A Prospective Cohort Study. Clin Transl Gastroenterol 2021; 12:e00332. [PMID: 33821842 PMCID: PMC8345912 DOI: 10.14309/ctg.0000000000000332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Azathioprine-induced pancreatitis is an idiosyncratic and unpredictable response, occurring in up to 7% of azathioprine-exposed patients with inflammatory bowel disease (IBD). The haplotype HLADQA1-HLADRB1*07:01A>C is strongly associated with azathioprine-induced pancreatitis in IBD. We aimed to evaluate whether pretreatment HLADQA1-HLADRB1*07:01A>C screening will reduce the risk of azathioprine-induced pancreatitis. METHODS Participants with IBD were screened for HLADQA1-HLADRB1*07:01A>C, and participants with a variant genotype were excluded from azathioprine treatment. Wild-type participants were started on azathioprine and followed for 3 months. The incidence of pancreatitis was compared with unscreened historical controls. RESULTS HLADQA1-HLADRB1*07:01A>C screening resulted in an 11-fold reduction in the incidence of azathioprine-induced pancreatitis (n = 1/328 or 0.30% vs n = 13/373 or 3.4%). In propensity score-matched cohorts (age and sex), HLA DQA1-HLADRB1*07:01A>C screening was significantly associated with a reduction in the incidence of AZA-induced pancreatitis independent of weight, glucocorticoid exposure, and smoking status (adjusted odds ratio = 0.075, 95% confidence interval = 0.01-0.58, P = 0.01). Up to 45% (n = 271/599) of participants were excluded from azathioprine therapy based on the haplotype in the HLADQA1-HLADRB1*07:01A>C-screened cohort. DISCUSSION HLADQA1-HLADRB1*07:01A>C screening reduced the risk of azathioprine-induced pancreatitis; however, using this strategy to guide the use of azathioprine therapy in IBD may eliminate a large proportion of patients from being eligible for treatment with azathioprine. In regions where there is access to other IBD therapies, and given the short-term and long-term toxicities associated with azathioprine, HLADQA1-HLADRB1*07:01A>C-screening may be a clinically relevant strategy for enhancing the safe use of azathioprine in IBD. In addition, cost-effectiveness analyses are needed to further solidify the utility of HLADQA1-HLADRB1*07:01A>C screening in IBD populations.
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Affiliation(s)
- Aze Wilson
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Qian Wang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Terry Ponich
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - James C. Gregor
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Nilesh Chande
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Brian Yan
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Melanie Beaton
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Richard B. Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
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Yuan CC, Zhu QT, Shen QH, Xu XM, Xu Y, Yang Q, Li BQ, Lu GT, Li WQ. Isoliquiritigenin ameliorates doxorubicin-induced acute pancreatitis by inhibiting ROS production via modulation of Nrf2/HO-1 oxidative stress pathway. Shijie Huaren Xiaohua Zazhi 2021; 29:282-290. [DOI: 10.11569/wcjd.v29.i6.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several case studies have reported that doxorubicin (DOX) could induce acute pancreatitis, but no animal experiments have confirmed such side effect of DOX, and there is no specific treatment. Isoliquiritigenin (ISL) has a variety of pharmacological functions, including anti-inflammatory and antioxidant activities; however, the role and mechanism of ISL on DOX-induced acute pancreatitis (DAP) remain unclear.
AIM To confirm whether doxorubicin (DOX) results in pancreatic tissue injury, and to determine the role and mechanism of isoliquiritigenin (ISL) in protecting against DOX-induced pancreatitis.
METHODS Male ICR mice (25-30 g) were randomly divided into a control group (intraperitoneal injection of normal saline), DOX-DAP model group (intraperitoneal injection of DOX 10 mg/kg every other day), and ISL treatment group (DOX + ISL group; intraperitoneal injection of DOX 10 mg/kg every other day and intragastric administration of ISL 100 mg/kg per day), with 8 mice in each group. Pancreatic histopathology and scoring were performed 5 d after modeling. The expression of alpha amylase in pancreatic tissue was detected by immunohistochemistry. Immunofluorescence assay was used to detect ROS production in pancreatic tissue. Protein expression of Nrf2 and HO-1 in pancreatic tissue was detected by Western blot.
RESULTS Compared with the control group, the mice in the DOX-DAP model group showed characteristic pathological damage, such as pancreatic tissue edema and inflammatory cells infiltration, with significantly increased histopathological scores (P < 0.001) and decreased expression of alpha amylase in the pancreas (P < 0.01). Compared with the DOX-DAP model group, the DOX + ISL group had significantly decreased histopathological scores (P < 0.05) and increased expression of alpha amylase in the pancreas (P < 0.05). ROS fluorescence staining and Western blot analysis showed that compared with the control group, ROS generation in pancreatic tissue in the DOX-DAP model group was significantly increased (P < 0.001), and the expression levels of Nrf2 and HO-1 proteins were slightly increased (P < 0.001). Compared with the DOX-DAP group, the DOX + ISL group had significantly decreased ROS levels in pancreatic tissuesed (P < 0.001), and significantly increased expression of Nrf2 and HO-1 proteins (P < 0.001).
CONCLUSION DOX can cause pancreatic pathological damage in mice, which is mainly characterized by pancreatic tissue edema and inflammatory cells infiltration. ISL administration has a protective effect on DOX-induced pancreatitis by enhancing the antioxidant stress level in pancreatic tissue, which is expected to provide a new method for the prevention and treatment of drug-induced pancreatitis.
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Affiliation(s)
- Chen-Chen Yuan
- Affiliated Jinling Hospital, Medical School of Nanjing University/General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002, Jiangsu Province, China
| | - Qing-Tian Zhu
- Department of Gastroenterology/Pancreas Center, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Qin-Hao Shen
- Department of Gastroenterology/Pancreas Center, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Xing-Meng Xu
- Department of Gastroenterology/Pancreas Center, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Yao Xu
- Affiliated Jinling Hospital, Medical School of Nanjing University/General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002, Jiangsu Province, China
| | - Qi Yang
- Affiliated Jinling Hospital, Medical School of Nanjing University/General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002, Jiangsu Province, China
| | - Bai-Qiang Li
- Affiliated Jinling Hospital, Medical School of Nanjing University/General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002, Jiangsu Province, China
| | - Guo-Tao Lu
- Department of Gastroenterology/Pancreas Center, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Wei-Qin Li
- Affiliated Jinling Hospital, Medical School of Nanjing University/General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002, Jiangsu Province, China
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Sharma S, Weissman S, Aburayyan K, Acharya A, Aziz M, Systrom HK, Lew D, Vohra I, Feuerstein JD, Pandol SJ. Sex differences in outcomes of acute pancreatitis: Findings from a nationwide analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:280-286. [PMID: 33417740 DOI: 10.1002/jhbp.890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sex is thought to play a significant role in predicting outcomes in numerous diseases. The role sex plays in acute pancreatitis (AP) remains limited. We sought to determine if sex is associated with hospitalization outcomes in this population, using a large national database. METHODS This was a retrospective study of adult patients with AP utilizing the 2016 and 2017 National Inpatient Sample via ICD-10 codes. The clinical courses of females were compared to that of males. The primary outcome was all-cause inpatient mortality. Secondary outcomes, including healthcare utilization, were assessed. Statistical analyses were performed using STATA, version 16.1. RESULTS Of the 553 480 adult patients hospitalized with AP; 25.3% had AP secondary to alcohol (61.4% male, 38.6% female) and 17.44% secondary to gallstones (48.6% male, 51.4% female). Females were significantly older than males (52.81 years vs 50.97 years, P < .01). Females had a significantly lower likelihood of mortality (aOR: 0.69), shock (aOR: 0.64), sepsis (aOR: 0.70), acute kidney injury (aOR 0.66), intensive care unit admission (aOR 0.53), and pancreatic drainage (aOR 0.61) as compared to males (all with P < .01). There was no significant difference between females and males with regards to mean length of stay and hospitalization charges and costs. CONCLUSIONS In this large cohort of patients admitted for AP, despite being significantly older, we found that females had significantly improved clinical outcomes, including lower mortality, compared to males. Further prospective studies are needed to accurately understand these differences to guide clinical practice.
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Affiliation(s)
- Sachit Sharma
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kanana Aburayyan
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Hannah K Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Lew
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ishaan Vohra
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Shah N, Razzano A, Grendell J. Doxycycline Induced Severe Acute Pancreatitis: A Rare Finding To A Common Medication. BMJ Case Rep 2021; 14:14/2/e239640. [PMID: 33547098 PMCID: PMC7871261 DOI: 10.1136/bcr-2020-239640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Doxycycline is a commonly prescribed antibiotic with growing evidence suggesting a possible linkage with drug-induced acute pancreatitis. We present an elderly female presenting with severe acute pancreatitis likely secondary to doxycycline therapy after thorough investigation. We reviewed the evidence linking doxycycline-inducing acute pancreatitis and signs and symptoms for severe disease. Early recognition and intervention are critical for positive patient outcomes.
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Affiliation(s)
- Neal Shah
- Department of Internal Medicine, NYU Langone Hospital - Long Island, Mineola, New York, USA
| | - Anthony Razzano
- Department of Gastroenterology and Hepatology, NYU Langone Hospital - Long Island, Mineola, New York, USA
| | - James Grendell
- Department of Gastroenterology and Hepatology, NYU Langone Hospital - Long Island, Mineola, New York, USA
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Drake M, Dodwad SJM, Davis J, Kao LS, Cao Y, Ko TC. Sex-Related Differences of Acute and Chronic Pancreatitis in Adults. J Clin Med 2021; 10:300. [PMID: 33467580 PMCID: PMC7830423 DOI: 10.3390/jcm10020300] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of acute and chronic pancreatitis is increasing in the United States. Rates of acute pancreatitis (AP) are similar in both sexes, but chronic pancreatitis (CP) is more common in males. When stratified by etiology, women have higher rates of gallstone AP, while men have higher rates of alcohol- and tobacco-related AP and CP, hypercalcemic AP, hypertriglyceridemic AP, malignancy-related AP, and type 1 autoimmune pancreatitis (AIP). No significant sex-related differences have been reported in medication-induced AP or type 2 AIP. Whether post-endoscopic retrograde cholangiopancreatography pancreatitis is sex-associated remains controversial. Animal models have demonstrated sex-related differences in the rates of induction and severity of AP, CP, and AIP. Animal and human studies have suggested that a combination of risk factor profiles, as well as genes, may be responsible for the observed differences. More investigation into the sex-related differences of AP and CP is desired in order to improve clinical management by developing effective prevention strategies, diagnostics, and therapeutics.
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Affiliation(s)
| | | | | | | | - Yanna Cao
- Department of Surgery, UT Health Houston, Houston, TX 77030, USA; (M.D.); (S.-J.M.D.); (J.D.); (L.S.K.)
| | - Tien C. Ko
- Department of Surgery, UT Health Houston, Houston, TX 77030, USA; (M.D.); (S.-J.M.D.); (J.D.); (L.S.K.)
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A rare case of metronidazole induced recurrent pancreatitis. Pancreatology 2021; 21:318-319. [PMID: 33189574 DOI: 10.1016/j.pan.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022]
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Mehershahi S, Haider A, Shaikh D, Abbas H, Ihimoyan A. Drug-Induced Acute Pancreatitis After Long-Term Sulfasalazine Therapy. Cureus 2020; 12:e10441. [PMID: 33072451 PMCID: PMC7557114 DOI: 10.7759/cureus.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
The list of drugs associated with acute pancreatitis is increasing with each passing year. Nevertheless, knowledge of drug-induced pancreatitis (DIP) are often curtailed by the limited availability of evidence needed to implicate given agents, especially for non-prescription medications. Indeed, the majority of available data are derived from case reports, case series, or case-control studies. We present a case chemically and radiologically proven pancreatitis in a 43-year-old female who was on sulfasalazine as a maintenance therapy for ulcerative colitis.
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Affiliation(s)
| | - Asim Haider
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Danial Shaikh
- Medicine/Gastroenterology, BronxCare Health System, Bronx, USA
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Hafsa Abbas
- Gastroenterology, BronxCare Health System, Bronx, USA
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