A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis

Abstract

Background: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. Case Report: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to rechallenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. Conclusion: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.