Favipiravir

Abstract

Acute pancreatitis following an off-label use: case reportA 37-year-old man developed acute pancreatitis during off-label treatment with favipiravir for COVID-19. The man, who was a non-smoker, non-alcoholic and diabetic, presented at the local health facility in Bangladesh with a 3-day history of throat pain, mild dry cough and low-grade fever. Three days later, his nasopharyngeal swab test for RT-PCR for SARS-CoV-2 showed a positive result, which confirmed the diagnosis of COVID-19. At the time of the report, his fever and other symptoms were resolved. Subsequently, he was referred to the local health facility, and started receiving off-label treatment with oral favipiravir 1600mg tablet as starting dose, followed by 600mg twice daily, scheduled for 7 days. Concomitantly, he received various other medications. On day 7 of favipiravir schedule (02 August 2020), he suddenly developed severe abdominal pain mainly in the epigastric region, which was radiated to the back. He also had several episodes of vomiting, without any diarrhoea or haematemesis. He had constipation and gradual distension of his abdomen. His urine colour and volume were normal. He had altered conscious level with incoherent speech, He had no history of fever, headache or convulsion.Therefore, the man was referred to the hospital for further management, and on 06 August 2020, he was hospitalised. On admission, he was slightly disoriented with incoherent speech. His Glasgow Coma Scale (GCS) score was 14/15. His vital signs test results were as follows pulse: 105 /min, BP 90/70mm Hg and temperature 98°F. He had normal oxygen saturation. His abdomen was distended with no organomegaly. Additionally, moderate ascites was observed with sluggish bowel sound. Other system examinations showed no abnormality. Subsequently, a diagnosis of acute pancreatitis with associated acute kidney injury was made. Laboratory test results revealed low Hb level, mild hyponatraemia and mild hypocalcaemia. His fasting lipid profile was normal. Ultrasonography of the whole abdomen showed a swollen and mildly oedematous pancreas with homogeneous echotexture. It also showed moderate ascites and mild hepatomegaly. The plain X-ray of the abdomen showed several air-fluid levels at the small bowel. Therefore, he received conservative treatment with IV fluid supplementation, injectable antibiotic treatment with meropenem and moxifloxacin, omeprazole and unspecified analgesic. He also received enoxaparin sodium [enoxaparin]. Subsequently, his abdominal pain slowly improved, with the resolution of constipation. The abdominal distension also improved with the normalisation of bowel sound. Therefore, oral food intake was restored. Two days later, his serum creatinine level reached 6.79 mg/dL, followed by an improvement in renal function. He did not require dialysis. On 19 August 2020, he was discharged from hospital. His renal function almost became normal with no abdominal complaints. He did not require invasive procedures or supplemental oxygen therapy during hospitalisation. At di...