Pravallika Chadalavada, MD1, Abdul Mohammed, MD2, Carlos Roberto Simons-Linares, MD, MSc2, Prabhleen Chahal, MD2; 1Cleveland Clinic Foundation, Rocky River, OH; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Drug-related adverse events are responsible for 0.1%-2% of acute pancreatitis (AP). Prevention of these incidents requires a thorough understanding of the drugs with the most substantial evidence connecting their use to the development of pancreatitis. We aimed to study the etiology (causative drugs), presentation, hospital course, and outcome of drug-induced acute pancreatitis (DIAP). Methods: Retrospective study of all patients admitted with DIAP at our large tertiary teaching hospital from January 2012 to December 2018. The diagnosis and severity of pancreatitis were determined based on the Revised Atlanta Classification. The cases were further subclassified using the Naranjo scores to evaluate and determine the odds of drug-related adverse reaction as a causative factor for AP. Results: Out of 841 AP patients, a total of 31 patients (3.6%) with DIAP were included. The mean age was 52.9 years, 51.6% were male. (Table 1A and 1B) The most common causative drugs were hydrochlorothiazide (class II) 8 cases (25.8%) followed by Azathioprine (class IA) 3 cases (9.6%) and Doxycycline (class III) 2 cases (6.4%). The severity of AP was mild in 87%, moderate in 6.5%, and severe 6.5% of the patients. 19.3% had systemic inflammatory response syndrome at presentation, but it persisted beyond 48 hours in only 9.6%. Acute kidney injury developed in 9.6% of the patients. One patient with valproate induced DIAP had pancreatic necrosis, splenic vein thrombus, and sub occlusive superior mesenteric vein thrombus on abdominal imaging. Three (9.6%) patients had recurrent AP, and two (6.5%) of them eventually developed chronic pancreatitis. Notably, none of our patients developed complications such as shock, acute respiratory distress syndrome, bacteremia, or death. One patient had an acute peripancreatic fluid collection on initial imaging, and another patient developed a pseudocyst on follow up imaging. None of them required drainage. (Table 2). The details of the causative drugs and their respective dosing, latency period, and Naranjo scores are displayed in Table 3. Discussion: DIAP is rare and has a milder course with fewer moderate or severe episodes of AP. Various drugs are implicated in causing AP with hydrochlorothiazide, azathioprine, and doxycycline being the common culprit drugs in our study.
Disclosures: Pravallika Chadalavada indicated no relevant financial relationships. Abdul Mohammed indicated no relevant financial relationships. Carlos Roberto Simons-Linares indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.