P14: DOXYCYCLINE: A RARE CAUSE OF DRUG INDUCED PANCREATITIS

Purpose of Study

Drug-induced pancreatitis (DIP) is a rare clinicopathologic entity. We report a 58-year-old female who developed DIP secondary to administration of doxycycline.

Methods Used

A 48 year old female with a history of hypertension presented to the hospital with complains of nausea/vomiting, right upper-quadrant gnawing abdominal pain, 8/10 in intensity with radiation to the back. She denied exacerbating factors, use of alcohol, tobacco and drug. Patient also denied diarrhea, constipation and changes in skin or stool color. On examination patient was hypertensive (155/95) with a heart rate of 102. She had epigastric/right upper quadrant tenderness on superficial palpation, hypoactive bowel sounds without any palpable organs, rebound tenderness or rigidity. Serum lipase was elevated at 2508 IU/L, negative pregnancy and insignificant urinalysis findings. Liver function tests, lipid panel, chemistry panel and hematologic panel were within normal limits. Radiologic investigations with abdominal ultrasound depicted mild proximal dilatation of the common bile duct with smooth tapering of the duct distally indicating status post-cholecystectomy. Contrast enhanced computed tomography scan revealed mild enlargement of the body of the pancreas with adjacent peripancreatic fatty infiltration consistent with acute pancreatitis. Upon further questioning patient explains recent diagnosis (7 days) of tibial orthopedic hardware infection as she was prescribed doxycycline 200 mg twice a day in anticipation of irrigation of infected site. After confirmation, and discontinuation of doxycycline, our patient recovered and has been disease-free for over a month.

Summary of Results

Drug-induced pancreatitis is uncommon etiology of acute pancreatitis, which is responsible for 0.1%–2% of all the acute pancreatitis cases. Among adverse drug reactions, pancreatitis is often-ignored because of the difficulty in implicating a drug as its cause.

Conclusions

In our vastly evolving pharmacotherapy world, DIP should be included in the differential of idiopathic pancreatitis, especially after other common causes have been ruled out.

Hypereosinophilic syndrome with cardiac involvement in a pregnant patient with multiple sclerosis

In hypereosinophilic syndrome, the sustained overproduction of eosinophils leads to the dysfunction of one or more organs. Symptoms vary in accordance with which organ is affected. Cardiac involvement leads to substantial morbidity and to most of the deaths that are associated with hypereosinophilic syndrome.Herein, we present the case of a 31-year-old woman, pregnant for 12 weeks and with a history of multiple sclerosis, who presented with transient vision loss and splinter hemorrhages in her fingernail beds. The diagnosis was hypereosinophilic syndrome with cardiac involvement. Echocardiography revealed 2 echodense structures: one that obliterated the left ventricular apex, and another in the basal lateral wall. The patient underwent therapy with prednisone and heparin but developed heparin-induced thrombocytopenia. This condition resolved when argatroban was substituted for heparin. Two weeks after the patient's release from the hospital, echocardiography revealed improvement in the echodense ventricular structures. The transient vision loss and the splinter hemorrhages were attributed to the hypereosinophilic syndrome.We believe that this is the 1st report of a pregnant patient with hypereosinophilic syndrome and cardiac involvement.