A Case of Fatal Necrotizing Pancreatitis: Complication of Hydrochlorothiazide and Lisinopril Therapy

Abstract

We report a case of fatal necrotizing pancreatitis associated with hydrochlorothiazide and lisinopril therapy. A 49-year-old man who presented with 2 days of abdominal pain and vomiting was found to have severe pancreatitis. The patient denied any alcohol use. In addition, abdominal ultrasound examinations showed no evidence of cholelithiasis or bile duct dilations. Review of his medication history with the family revealed that he was being treated with hydrochlorothiazide and lisinopril for hypertension. An exploratory laparotomy was performed and revealed no common bile duct stones. Unfortunately, the patient's hospital course was complicated with multiple organ failure, which resulted in death. To the best of our knowledge, there are only 3 other reported cases of hydrochlorothiazide-induced necrotizing pancreatitis reported in the literature.

Effects of Medications on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

“…Other medications such as diuretics [8], glucophage [24] and sulfonylureas [9] have also been reported as the possible etiology for acute pancreatitis. However, none of them is an independent risk factor for developing post-ERCP pancreatitis in the current retrospective study.…”

“…Since the risk of developing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is up to 15.1% [5], reports of propofol-related pancreatitis raise additional concern for physicians attempting to minimize risk to their patients. Other clinically commonly used medications such as angiotensin converting enzyme (ACE) inhibitors, diuretics and sulfonylureas have also been reported as the etiologies for acute pancreatitis [6,7,8,9]. This study was conducted to investigate the effect of propofol and other medications on the incidence of acute post- ERCP pancreatitis.…”

When ESKD complicates disease management: GI bleeding and other GI illnesses

“…Patients on PD also had a higher rate of necrotizing pancreatitis 17 . The preferred antihypertensive agents to preserve RKF are angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers, but there is an association of their use and pancreatitis 18–20 …”

Lisinopril-Induced Acute Necrotizing Pancreatitis

“…To the best of our knowledge, based on an extensive review of the literature using PubMed, Google Scholar, and Medline only one other case has been reported about necrotizing pancreatitis with the use of lisinopril [ 4 ]. The exact mechanisms for angiotensin-converting enzyme (ACE) inhibitor-induced pancreatitis are unknown; however, many theories have been proposed.…”

“…Some studies suggest that they may cause an increase in pancreatic enzymes (amylase and lipase) production as well as the formation of antibodies directed against the pancreatic cells [ 2 ]. ACE inhibitors are antihypertensives that may also precipitate pancreatic ischemia [ 4 ].…”