University of Oklahoma Health Sciences Center Oklahoma City, OK, United States
Andrea T. Fernandez, MD1, Khawaja H. Akhtar, MD2, Satyam Krishan, MD1, Muhammad Faraz Anwaar, MD1, Mark Allee, MD1 1University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2Oklahoma University Health Sciences Center, Oklahoma City, OK
Introduction: Liraglutide and Empagliflozin are glucagon-like peptide-1 receptor agonist and sodium-glucose transport protein 2 (SGLT2) inhibitor respectively, commonly used in the management of diabetes mellitus type-II due to improved cardiovascular outcomes. We present a case of a middle-aged adult with necrotizing pancreatitis complicated by a large pancreatic pseudocyst in the setting of liraglutide and empagliflozin use.
Case Description/Methods: A 48-year-old male with history of diabetes mellitus type-II, presented to the emergency room with acute abdominal pain, radiating to his back, intractable nausea and vomiting. Physical exam was significant for tenderness to palpation in epigastrium. Lab work was notable for elevated white blood cell count at 17.53 K/mm3, elevated serum total bilirubin at 1.56 mg/dL, serum lactic acid 3.0 mmol/L, and normal lipase levels. Computerized tomography scan of abdomen and pelvis showed large peripancreatic fluid collection measuring 21 x 11 x 14 cm. On further investigation, it was found that patient was recently diagnosed with acute pancreatitis at an outside hospital and received supportive care. Further workup did not reveal cholelithiasis, chronic alcohol use, hypertriglyceridemia, trauma, malignancy or systemic infections. Close review of medications showed that patient was started on liraglutide and empagliflozin two months prior to the initial episode of pancreatitis. During the admission, he received treatment with fluid resuscitation and broad-spectrum antibiotics. Subsequently, endoscopic ultrasound guided cystogastrostomy with direct endoscopic necrosectomy was performed. Patient had significant improvement in his symptoms post-procedure.
Discussion: Acute pancreatitis associated with liraglutide although rare (< 1%), is well known. SGLT2 inhibitors, especially empagliflozin, have demonstrated a better side effect profile with mild gastrointestinal adverse events. Further literature review suggests a few case reports where empagliflozin has been associated with acute pancreatitis. In the case described above, it is difficult to identify the exact etiology behind necrotizing pancreatitis. Given the association of both these medications with pancreatitis, they were discontinued at the time of diagnosis. While cholelithiasis and chronic alcohol use comprises two-thirds of acute pancreatitis cases, drug-induced pancreatitis remain an important differential. A careful review of patient’s current medications should be prioritized to avoid recurrent episodes.
Andrea Fernandez indicated no relevant financial relationships.
Khawaja Akhtar indicated no relevant financial relationships.
Satyam Krishan indicated no relevant financial relationships.
Muhammad Faraz Anwaar indicated no relevant financial relationships.
Mark Allee indicated no relevant financial relationships.
Andrea T. Fernandez, MD1, Khawaja H. Akhtar, MD2, Satyam Krishan, MD1, Muhammad Faraz Anwaar, MD1, Mark Allee, MD1. P2154 - Necrotizing Pancreatitis Associated With Liraglutide and Empagliflozin, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.