Acute pancreatitis caused by tigecycline

Abstract

Rationale: There is evidence that tigecycline has broad-spectrum antibiotic activity against a variety of complicated infections. However, adverse effects are inevitable, including gastrointestinal side effects such as nausea, vomiting, and diarrhea; in 2006, acute pancreatitis was also brought into the side-effect list after postmarketing surveillance. Here, we present a case of tigecycline-induced acute pancreatitis. Patient concerns: An 87-year-old female patient with urinary tract infection received an intravenous drip of tigecycline for 6 days, after which she developed abdominal distension, vomiting, abdominal pain, and abdominal rigidity. Diagnosis: The patient was suspected to have tigecycline-induced acute pancreatitis. Interventions: Tigecycline was discontinued immediately, and the patient received a series of immediate treatments including an indwelling gastric tube for continuous gastrointestinal decompression and inhibition of gastric acid and pancreatic enzyme secretion. Outcomes: Following initial interventions, we observed that the patient's symptoms improved significantly, and abdominal distension, vomiting, abdominal pain, and abdominal rigidity were slightly relieved. After 5 days of follow-up, blood lipase and amylase levels decreased to normal levels. Unfortunately, the patient developed convulsions during the use of multiple antibiotics after 1 week and then died of septic shock and acute liver failure. Lessons: Acute pancreatitis caused by tigecycline is rare. However, in the application of antibiotics, the possibility of adverse effects must be considered, and antibiotics should be used reasonably. If the patient has relevant symptoms, it is necessary to stop using tigecycline immediately, carry out symptomatic treatment, and change to other types of antibiotics for antibacterial treatment.

The Spectrum of Tigecycline-Induced Pancreatitis in Clinical Characteristics, Diagnosis, and Management

“…Four patients (11.8%) died, of whom two died from severe pancreatitis complications, 26 , 31 and two died of cardiogenic shock and septicemia. 22 , 30…”

Tigecycline Tango: A Case of Antibiotic-Induced Pancreatitis

“…Tigecycline, a derivative of the tetracycline class of drugs, was first approved by the Food and Drug Administration in 2005 for the treatment of various types of infections, such as skin and soft tissue infections, intra-abdominal infections, and bacterial pneumonia. Developed to overcome the common mechanisms of resistance such as ribosomal protection and efflux pumps [ 3 ], tigecycline's safety profile initially listed adverse effects such as nausea, vomiting, and diarrhea. However, it wasn't until a retrospective cohort study and a review of phase III trials that pancreatitis was identified as a potential adverse effect [ 4 ].…”

“…With the rise of multidrug-resistant organisms, tigecycline's ability to inhibit these organisms in vitro has led to its off-label use for the treatment of these infections [ 4 ] and may be contributing to the rise in the incidence of pancreatitis. Several mechanisms have been proposed to explain the link between tigecycline use and pancreatitis, including the production of toxic metabolites, elevation of triglyceride levels, and high drug accumulation in the biliary system [ 3 ].…”

“…In a literature review of 11 case reports published in Dec 2021 byPeng-fei Wang et al [ 3 ], almost all cases of acute pancreatitis developed within about 2 weeks of initiation of tigecycline except one case report where it was after 4 weeks [ 8 ]. In our case, the patient started experiencing symptoms of acute pancreatitis on day 12 of tigecycline use, and was admitted to the hospital on day 14 of tigecycline treatment.…”

“…However, when these common causes have been ruled out, a thorough review of the patient's history and medication list may be necessary to uncover an unusual cause such as medication-induced pancreatitis. Although the incidence of tigecycline-induced pancreatitis remains very low (less than 1%) [ 3 ], it is imperative to have a suspicion and subsequent plan to discontinue usage of this drug as soon as possible when no obvious common etiologies are discovered. In our patient’s case, after ruling out other likely causes, tigecycline emerged as the most probable reason for her pancreatitis.…”