Epidural Steroid Injection-Induced Pancreatitis: A Case Report

Abstract

Rare co-existance of disease or pathology Background:Degenerative disc disease of the lumbar spine can be associated with spinal canal and neuroforaminal stenosis, resulting in severe pain. Conservative approaches to treatment are generally recommended initially, especially in the elderly. Epidural corticosteroid injections can provide significant but temporary pain relief and are a commonly performed procedure in pain management. Pancreatitis caused by corticosteroids is unusual and the prognosis typically is good. Case Report:A 73-year-old woman presented with severe intractable back pain 1 week after lumbar epidural steroid injection for symptomatic spinal stenosis. Imaging confirmed severe multi-level degenerative disc disease of the lumbar spine resulting in severe canal and bilateral neuroforaminal stenosis. Because of abdominal pain and nausea, an abdominal CT and labs were performed, revealing evidence of pancreatic inflammation. Conclusions:Lumbar epidural steroid injection may be a risk factor for developing steroid-induced pancreatitis.

Intra-articular Steroid Injection as the Etiology of Acute Pancreatitis

“…Intra-articular steroid injections as a cause has only been reported once before in a Letter to the Editor [4]. There is one report of a case of pancreatitis due to a lumbar epidural steroid injection [7]. Our patient had been on long-term topical fluticasone and budesonide for EoE without any episodes of pancreatitis, so this is not likely the etiology.It is interesting that our patient received a triamcinolone injection in the past, which has been shown to have more of a systemic effect, but did not develop pancreatitis.…”

High-dose intravenous glucocorticoid induces hyperamylasemia: a case series

“…Previous studies have reported that GCs can lead to acute pancreatitis [ 12 – 14 ]. China’s latest guidelines [ 15 ] suggest that the diagnosis of acute pancreatitis should meet at least two of the following three criteria: (1) acute, sudden, persistent, severe upper abdominal pain, which may radiate to the back; (2) serum amylase and/or lipase activities at least three times higher than the upper limit of normal levels; (3) enhanced CT/MRI showing typical AP imaging changes (pancreatic edema or peripancreatic effusion).…”

A Case of Acute Pancreatitis in a Patient Receiving High-Dose Steroids for Optic Neuritis

“…A thorough review of the patients’ medications is important in all cases of acute pancreatitis. A clear history of recent steroid use, in the absence of other causes of acute pancreatitis, warrants immediate cessation of steroids to prevent further pancreatic damage [ 8 ].…”