CASO CLÍNICOAcute fulminant drug induced necrotizing pancreatitis in a patient with ankylosing spondylitis
AbstractDrug-induced acute necrotizing pancreatitis is a rare adverse event, although it has been reported in association with different drugs. Clinical cases of acute pancreatitis complicating treatment with anti-TNF-α such as infliximab have been exceptionally reported. We describe a patient with ankylosing spondylitis treated with etanercept who developed an acute fulminant necrotizing pancreatitis that resulted in death. Key words: acute pancreatitis; etanercept; anti-TNF-α agents; ankylosing spondylitis.
ResumenLa pancreatitis aguda necrotizante inducida por medicamentos es un efecto adverso raro, y ha sido descrito en asociación con diferentes fár-macos. Los casos clínicos de pancreatitis aguda secundarias a tratamiento con anti-TNF-α como el infliximab se han descrito de forma excepcional. Por el contrario, se ha informado de un efecto de mejora de los agentes anti-TNF-α en la pancreatitis aguda inducida experimentalmente en modelos animales. Describimos un paciente con espondilitis anquilosante tratado con etanercept que desarrolló una pancreatitis necrotizante aguda fulminante que resultó en el fallecimiento del paciente. Palabras clave. Pancreatitis aguda. Etanercept. Agentes anti-TNF-α. Espondilitis anquilosante
IntroductionDrug-induced acute necrotizing pancreatitis is a rare adverse event, and it has been reported in association with different drugs [1][2][3] . Clinical cases of acute pancreatitis complicating treatment with anti-TNF-α such as infliximab have been exceptionally reported 4 . Contrarily, an ameliorating effect of anti-TNF-α agents on experimentally-induced acute pancreatitis in animal models has been reported [5][6][7][8] . We describe a patient with ankylosing spondylitis treated with etanercept who developed an acute fulminant necrotizing pancreatitis that resulted in death.
Case reportA 57-year-old man was admitted to the emergency department because of epigastric pain of one week's duration. The patient was diagnosed of ankylosing spondylitis at the age of 27 and he was treated with repeated courses of NSAIDs to which etanercept was finally added due to lack of efficacy. Six months after starting anti-TNF-α therapy the disease was inactive and the patient only took indomethacin sporadically with omeprazole for gastric protection. He did not have a history of dyslipidemia or alcohol consumption. Abdominal pain was unrelated to food intake and was not accompanied by nausea, vomiting, or changes in the bowel habits. Physical examination revealed mucocutaneous jaundice and pain in the epigastrium on deep palpation without signs of peritoneal irritation. Laboratory tests on admission showed a serum bilirubin level of 6.3 mg/dL (direct bilirubin 3.6 mg/dL), alkaline phosphatase 177 mg/dL, aspartate aminotransferase 470 mg/dL, and alanine aminotransferase 430 mg/dL. The serum lipid profile, ions and amylase in serum and urine were within normal ranges. The abdominal ultrasound and ...
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