Thyroid storm is an extreme form of hyperthyroidism associated with a high mortality rate. Heart failure is considered the leading cause of mortality in patients with thyroid storm, though the underlying cardiac pathology is unclear. Approximately 6% of patients with thyroid storm have heart failure symptoms as the initial presenting complaint. Roughly, one-third of these patients develop dilated cardiomyopathy (DCM). In this report, we present a case of cardiogenic pulmonary edema and sustained ventricular tachycardia in a patient with hyperthyroidism presenting with thyroid storm.
INTRODUCTION:
Acute pancreatitis is a common condition in the US, with high mortality and burden on the health care system. In the US, it is one of the main causes of gastrointestinal related admissions with more than 291,000 hospitalization per year. The most common causes are alcohol use (30%) and gallstones (40%). Less frequently, drug induced. Interestingly, drug induced pancreatitis has excellent prognosis and low mortality. The mechanisms of drug induced pancreatitis include immunologic reactions, direct toxic effect, accumulation of toxic metabolites, ischemia, and intravascular thrombosis.
CASE DESCRIPTION/METHODS:
A 78-year-old woman with surgical history of cholecystectomy presented to the emergency room with a sudden onset of sharp epigastric pain radiating to the back, that was associated with vomiting, 60 minutes after taking Eluxadoline for the first time. She had a history of hypertension, diabetes mellitus, and irritable bowel syndrome with diarrhea (IBS-D) for which Eluxadoline was prescribed. On exam, she was hemodynamically stable and had epigastric tenderness without rebound. Laboratory tests remarkable for elevated lipase, 2754 U/L. Based on the Revised Atlanta criteria, patient had mild pancreatitis. A computed tomography of the abdomen and pelvis was unremarkable without biliary pathology. She was admitted for acute pancreatitis presumed secondary to Eluxadoline ingestion. The patient was treated conservatively and Eluxadoline was discontinued. Five hours later, her lipase was 68 U/L and symptoms resolved. She was advised to discontinue Eluxadoline and discharged home.
DISCUSSION:
The diagnosis of drug induced pancreatitis requires first the diagnosis of acute pancreatitis based on symptoms, biomarkers or imaging. Common causes, such as alcohol use and gallstones, must be ruled out. A medication review should be conducted to look for potential culprits. Any medication of suspect should be discontinued and resolution of pancreatitis should be appreciated. Eluxadoline is used in treatment of IBS-D. It reduces abdominal pain and lessens diarrhea frequency, but has been noted to be associated with acute pancreatitis in 82% of patients who has previously underwent cholecystectomy. It is thought to be due to spasms in the sphincter of oddi, leading to pancreatic duct hypertension. The FDA has suggested to avoid the use of this medication in these cases. Careful attention should be made to the potential adverse events, especially acute pancreatitis, in those patients on Eluxadoline.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.