scholarly journals Metronidazole-Induced Pancreatitis: Is There Underrecognition? A Case Report and Systematic Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ibrahim Youssef ◽  
Naba Saeed ◽  
Mohammad El Abdallah ◽  
Kara Huevelhorst ◽  
Kais Zakharia
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Causative Factor ◽  
Drug Induced ◽  
Concurrent Use ◽  
The Usa ◽  
History Of ◽  
Fat Stranding ◽  
Supportive Management ◽  
Severe Epigastric Pain

Introduction. Acute pancreatitis (AP) is the most common cause of gastroenterological hospitalization in the USA, with a mortality ranging from 5 to 20%. Up to 80% of cases are caused by cholelithiasis and alcohol abuse. Less common etiologies that need to be explored include hypertriglyceridemia, trauma, ERCP, infections, and drugs. A number of medications are known to cause acute pancreatitis, with 0.3-1.4% of all cases of pancreatitis being drug induced (DIP). Here, we present a case of metronidazole-induced acute pancreatitis. Case Summary. A 60-year-old female presented with constant severe epigastric pain associated with nausea, vomiting, and anorexia for one day. She had no past medical history of alcohol use or hypertriglyceridemia and was s/p cholecystectomy in the distant past. Symptoms had begun three days after starting metronidazole for Clostridium difficile colitis. Lipase was > 396, and CT abdomen revealed peripancreatic fat stranding. She was diagnosed with AP, metronidazole was suspected to be responsible and hence stopped, and supportive management initiated. Her symptoms improved rapidly, and pancreatic enzymes normalized within 2 days. Of note, she had had an episode of acute pancreatitis 3 years ago, also following metronidazole use, with resolution at discontinuation of the drug. She had concurrently been on omeprazole during both episodes. Discussion. Metronidazole is a commonly used antibiotic and is infrequently reported as a cause of DIP. Our review suggests the possibility of a dose-response and duration-response effect between metronidazole use and occurrence of pancreatitis. The most common presenting symptom and sign was moderate to severe epigastric pain and tenderness, accompanied by nausea/vomiting. Symptoms usually start within 2-7 days of starting the medication and usually resolve 2-5 days after discontinuation of therapy and pancreatitis treatment. The most common causative dose was 1-1.5 g/day. Our review also supports findings by Norgaard et al. suggesting that concurrent use of omeprazole potentiates the risk of metronidazole-induced pancreatitis. Conclusion. Metronidazole is a commonly used antibiotic that may cause metronidazole-induced pancreatitis, especially if patients are concurrently taking PPIs. Awareness needs to be raised amongst clinicians regarding this association, in order to correctly identify etiology of pancreatitis and discontinue metronidazole promptly when suspected as the causative factor.

scholarly journals Abdominal pain and a raised amylase? It’s not always pancreatitis…

2013 ◽  
Vol 12 (3) ◽  
pp. 163-165
Author(s):  
IO Oluwatowoju ◽  
◽  
EO Abu ◽  
G Lawson ◽  
◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Epigastric Pain ◽  
Elevated Serum ◽  
High Serum ◽  
Amylase Level ◽  
Serum Amylase Level ◽  
Heavy Alcohol ◽  
Heavy Alcohol Consumption ◽  
History Of

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

scholarly journals Acute Pancreatitis Secondary to a Perivaterian Duodenal Diverticular Abscess

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
P. Pastides ◽  
S. Bertaud ◽  
S. K. Sarker ◽  
S. Dindyal
Keyword(s):  
Magnetic Resonance Imaging ◽  
Acute Pancreatitis ◽  
Cystic Lesion ◽  
Causative Factor ◽  
Ampulla Of Vater ◽  
Uneventful Recovery ◽  
Resonance Imaging ◽  
History Of ◽  
The Common ◽  
Head Of Pancreas

A 46-year-old previously fit lady was admitted with acute pancreatitis. She had no history of gallstones. She was not on any medications and consumed minimal amounts of alcohol. On subsequent investigations as to the causative factor, she was found at ultrasound to have an air-fluid filled cystic structure posterior to the head of pancreas which was compressing the common bile duct. Further magnetic resonance imaging and computer tomography scans showed that this cystic lesion was located around the ampulla of Vater. A diagnosis of a perivaterian abscess was made. At endoscopy, a large contained abscess was seen which was successfully drained. She made a full and uneventful recovery.

scholarly journals Pravastatin-Induced Acute Pancreatitis: A Case Report and Literature Review

2021 ◽  
Vol 9 ◽  
pp. 232470962110283
Author(s):  
Zahid Ijaz Tarar ◽  
Muhammad Usman Zafar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Hafiz Muhammad Hassan Shoukat
Keyword(s):  
Acute Pancreatitis ◽  
Case Reports ◽  
Chronic Alcoholism ◽  
Unknown Etiology ◽  
Endoscopic Retrograde ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Common Causes ◽  
Fat Stranding ◽  
Tomography Scan

Pancreatitis is inflammation of pancreas associated most commonly with chronic alcoholism and gallstones. Other less common causes of pancreatitis are hyperlipidemia, infections, surgery, trauma, post endoscopic retrograde cholangiopancreatography, and drugs. Drugs are now increasingly recognized as a cause of pancreatitis, and high suspicion and exclusion of other most common causes is required before considering drug-induced pancreatitis. There are few case reports of acute pancreatitis in the literature after statin use, but out of these, only 3 are after starting pravastatin. We are reporting a case of 49-year-old male who presented with nausea, vomiting, and abdominal pain. His laboratory findings were significant for lipase more than 10 000 on admission, and computed tomography scan of abdomen was showing peripancreatic fat stranding and inflammation. After exclusion of most common causes of pancreatitis, pravastatin was found probable culprit for his symptoms, which he started taking 2 weeks ago. We also reviewed the literature on statins-induced acute pancreatitis. With increased uses of statins, physician need to be vigilant to suspect statins as a culprit in cases of pancreatitis with unknown etiology. Prompt discontinuation of statins is required in these cases.

scholarly journals A Suspected Case Of Endoscopic Ultrasound Induced Pancreatitis, Without Fine Needle Aspirate

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Michael John Abunassar BSc, BA, MD ◽  
Loree Boyle, BN, MD, FRCPC ◽  
Avijit Chaterjee, MSc, MDCM. FRCPC
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Pancreatic Cyst ◽  
Epigastric Pain ◽  
Stable Condition ◽  
Suspected Case ◽  
Fine Needle Aspirate ◽  
Recurrent Pancreatitis ◽  
Fine Needle ◽  
History Of

A 78-year-old male developed nausea and epigastric pain 8 hours following an endoscopic ultrasound (EUS) procedure. The patient had a history of recurrent pancreatitis, and underwent the EUS procedure with the aim of aspirating a pancreatic cyst. The cyst had regressed in size, in keeping with a pseuodocyst, and was not biopsied. The patient tolerated the procedure well with no immediate complications, and was discharged home in stable condition. Eight hours later, the patient developed acute pancreatitis.

scholarly journals ACUTE PANCREATITIS IN PREGNANCY

2012 ◽  
Vol 19 (05) ◽  
pp. 747-750
Author(s):  
SHAMA CHAUDHRY ◽  
RUBINA HUSSAIN
Keyword(s):  
Acute Pancreatitis ◽  
Caesarean Section ◽  
Maternal Mortality ◽  
Dermoid Cyst ◽  
Conservative Management ◽  
Epigastric Pain ◽  
Fetal Loss ◽  
Pedal Edema ◽  
Severe Epigastric Pain ◽  
In Pregnancy

Acute pancreatitis during pregnancy is rarely encountered and can have a high maternal mortality and fetal loss. We report herea case of a 35-year-old woman para 1+0 previous 1LSCS at 32 weeks of gestation. She had laparotomy at 29 weeks of gestation due to torsionof dermoid cyst in this pregnancy. Now she was presented with, severe epigastric pain, vomiting and pedal edema. Investigation revealedhyperamylasemia and leukocytosis, hypokalemia, hypocalcaemia. The patient was kept on conservative management, antibiotics, analgesics& intravenous fluids.Pancreatitis resolved & she delivered at 38 weeks by caesarean section.

scholarly journals Posaconazole-Induced Acute Pancreatitis: A Rare Side Effect in a Child with Chronic Granulomatous Disease

2020 ◽  
Vol 8 (4) ◽  
Author(s):  
Marjan Tariverdi ◽  
Sedigheh Rafiei Tabatabaei ◽  
Ali Saffaei ◽  
Ladan Ayazkhoo ◽  
Bahador Mirrahimi
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Granulomatous Disease ◽  
Fungal Infections ◽  
Epigastric Pain ◽  
Pediatric Population ◽  
Antifungal Prophylaxis ◽  
Granulomatous Disease ◽  
Drug Induced ◽  
Abdominal Sonography ◽  
First Case

Introduction: Pancreatitis is an inflammatory disease of the pancreas. Drug-induced pancreatitis is an important cause of pancreatitis. There are two pathological types of acute pancreatitis, including pancreatic edema with a mild course and pancreatic necrosis with a poor prognosis. Some agents can induce pancreatitis, but so far, posaconazole-induced pancreatitis in children has been not reported. Here, we describe the case of a child with acute pancreatitis who received posaconazole. Case Presentation: A 10-year-old girl with a three-year history of chronic granulomatous disease (CGD) was admitted to hospital due to epigastric pain, nausea, vomiting, loss of appetite, and fever for the last four days. The pain was persistent and prominent in the periumbilical area. The patient was on lifelong antifungal prophylaxis for her illness. On abdominal sonography, the head of the pancreas was inflated, which can indicate pancreatitis. All the medications were discontinued at the time of admission, and along with sufficient hydration, acetaminophen was administered for the patient’s pain. One, three, and twelve months after discharge, the patient was visited for follow-up with no signs of stomach discomfort, and the lab data was within the normal limits. CGD is a rare disease in which the phagocytes fail to produce hydrogen peroxide. Such patients are prone to bacterial and fungal infections. Conclusions: In conclusion, this is the second case of posaconazole-induced pancreatitis and the first case in children; thus, we recommend that physicians should be aware of the signs of pancreatitis in high-risk individuals like immunocompromised pediatric population.

Bictegravir/emtricitabine/tenofovir alafenamide-induced acute pancreatitis: a case report

2020 ◽  
Vol 31 (10) ◽  
pp. 1008-1010 ◽  
Author(s):  
Agostino Riva ◽  
Dario Cattaneo ◽  
Carlo Filice ◽  
Cristina Gervasoni
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Abdominal Ultrasound ◽  
Laboratory Examination ◽  
Pancreatic Parenchyma ◽  
Single Tablet Regimen ◽  
Serum Transaminases ◽  
Recent Diagnosis ◽  
Tenofovir Alafenamide ◽  
Severe Epigastric Pain

We report here the case of a 32-year-old male with recent diagnosis of HIV that, 45 days after starting a single tablet regimen co-formulated with bictegravir, emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), experienced severe epigastric pain radiating to the back, nausea, episodes of non-bloody non-bilious vomiting and anorexia. Laboratory examination showed a rise in lipase with no alterations in serum transaminases. Abdominal ultrasound revealed a non-homogeneous structure of the pancreatic parenchyma. A diagnosis of mild drug-related acute pancreatitis was made and BIC/FTC/TAF was immediately stopped. The association between the episode of acute pancreatitis and BIC/FTC/TAF was scored as probable according to the Naranjo causality scale.

Acute Liver Failure with Concurrent Bupropion and Carbimazole Therapy

2003 ◽  
Vol 37 (2) ◽  
pp. 220-223 ◽  
Author(s):  
Khoo Ai-Leng ◽  
Tham Lai-San ◽  
Lee Kang-Hoe ◽  
Lim Gek-Kee
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Concomitant Treatment ◽  
Probability Scale ◽  
Drug Induced ◽  
The Past ◽  
First Case ◽  
Concurrent Use ◽  
History Of ◽  
Fatal Liver Failure

OBJECTIVE: To report a case of fatal liver failure possibly associated with concurrent use of bupropion and carbimazole. CASE SUMMARY: A 41-year-old Chinese man with a history of hyperthyroidism had been treated with carbimazole and propranolol for the past 5 years. He received a 10-day course of bupropion as an aid for smoking cessation 10 weeks prior to presentation. He developed acute liver failure with rapid deterioration of renal function. Liver biopsy showed evidence of nonspecific drug-induced acute liver injury. His condition was further complicated by sepsis and coagulopathy. Death resulted 19 days after the onset of symptoms. The likelihood that bupropion induced hepatotoxicity in our patient was possible, based on the Naranjo probability scale. DISCUSSION: Although there is increasing evidence of hepatotoxicity induced by bupropion, this is the first case of fatality that could have resulted from acute liver failure in a patient receiving bupropion while on concomitant treatment with carbimazole. CONCLUSIONS: Clinicians should be aware of the possibility of acute liver insult induced by bupropion given concurrently with other hepatotoxic drugs.

scholarly journals Recurrent Acute Pancreatitis following Colonoscopic Fecal Microbiota Transplantation for Ulcerative Colitis

2021 ◽  
Author(s):  
Avnish Kumar Seth ◽  
Mahesh Kumar Gupta ◽  
Radha Krishan Verma
Keyword(s):  
Acute Pancreatitis ◽  
Fecal Microbiota Transplantation ◽  
Epigastric Pain ◽  
Symptomatic Treatment ◽  
Fecal Microbiota ◽  
Recurrent Acute Pancreatitis ◽  
Serum Lipase ◽  
Fecal Microbiota Transplant ◽  
Enhanced Computed Tomography ◽  
Severe Epigastric Pain

AbstractA 37-year-old man with corticosteroid-dependent ulcerative pancolitis was taken up for colonoscopic fecal microbiota transplant (FMT). Preparation for colonoscopy was done with 118 g polyethylene glycol (PEG) in 2 L water ingested over 2 hours, followed by clear fluids. 200 g of screened donor stool, blended with water was instilled into terminal ileum; cecum; and ascending, transverse, and descending colon. Eighteen hours following ingestion of PEG and 2 hours following FMT, he complained of severe epigastric pain with radiation to back. Serum lipase was 6,756 U/L. He was managed with intravenous (IV) fluids and symptomatic treatment with discontinuation of corticosteroids and 6-MP. Ultrasound did not reveal gall bladder stones or sludge. There was no history of alcohol intake. Contrast-enhanced computed tomography scan at 48 hours showed bulky pancreas with peripancreatic stranding. He recovered over a week with normalization of lipase. Three weeks later he again reported severe epigastric pain 14 hours following ingestion of PEG, this time prior to colonoscopic FMT. Serum lipase was 1,140 U/L; the procedure was deferred and he recovered with symptomatic treatment over 3 days. Maintenance colonoscopic FMT was performed 4 times over the following 2 years with sodium phosphate preparation with no recurrence of pain. MRCP showed no evidence of chronic pancreatitis. He remains in clinical and endoscopic steroid-free, thiopurine-free remission. PEG is a rare cause of acute pancreatitis and merits consideration in appropriate clinical setting.

scholarly journals Small Intestinal Strangulation Due to a Rare Type of Primary Internal Hernia

2013 ◽  
Vol 98 (4) ◽  
pp. 409-411 ◽  
Author(s):  
Makoto Takeda ◽  
Yoshinori Ohnuki ◽  
Takashi Uchiyama ◽  
Osamu Kubota ◽  
Kousuke Ohishi
Keyword(s):  
Internal Hernia ◽  
Epigastric Pain ◽  
Past History ◽  
Hepatic Flexure ◽  
Rare Type ◽  
Paracolic Gutter ◽  
Internal Hernias ◽  
History Of ◽  
The Right ◽  
Severe Epigastric Pain

Abstract Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.

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