DRUG-INDUCED PANCREATITIS: A CASE SERIES HIGHLIGHTING RARE ETIOLOGIES

Abstract

Background:

Drug-induced pancreatitis (DIP) is an uncommon cause of acute pancreatitis (AP), accounting for 0.1–2% of cases. Early recognition of offending medications is vital to reduce morbidity. Herein, we present two illustrative cases involving diuretic- and oral contraceptive-related DIP—both rare and under-reported triggers.

Case Presentation:

• Case 1: A 68-year-old female with atrial fibrillation and mitral valve replacement experienced acute-onset abdominal pain and vomiting. Laboratory values revealed markedly elevated amylase (6,942 U/L) and lipase (94,245 U/L). CT imaging confirmed interstitial pancreatitis with bilateral pleural effusions. Exclusion of gallstones, alcohol use, hypertriglyceridemia, and hypercalcemia bolstered the suspicion on recently initiated loop diuretic (furosemide). Discontinuation, along with supportive care from a multidisciplinary team, led to full recovery.
• Case 2: A 42-year-old woman on prolonged oral contraceptive pill (OCP) therapy for abnormal uterine bleeding presented with epigastric pain. Elevated pancreatic enzymes and CT imaging confirmed mild AP. Other common causes were excluded. OCPs were ceased, and conservative management resulted in clinical and laboratory resolution.

Conclusion:

These cases underscore that commonly prescribed medications like furosemide and OCPs—though rarely implicated—can cause DIP. Clinicians must maintain a high index of suspicion for DIP, obtain detailed medication histories, and promptly withdraw the culprit drug. Multidisciplinary coordination enhances patient recovery and prevents recurrence.