Don’t Settle For an Idiopathic Diagnosis When Further Investigation May Prove Drug-Induced Acute Pancreatitis

Acute pancreatitis is a sudden inflammatory process of the pancreas that may also involve peripancreatic tissues or remote organ systems [1]. It is associated with over 210,000 hospital admissions per year in the United States and the annual incidence of acute pancreatitis ranges from 5 to 80 cases per 100,000 persons, making it one of the most common gastroenterological conditions [2,3]. The highest incidence rates of acute pancreatitis are found in the United States and Finland [3]. A common cause includes gallstones and heavy alcohol use, accounting for 30% to 60% and 15% to 30% of cases, respectively [4]. Other causes include smoking, hypertriglyceridemia, hypercalcemia, hyperparathyroidism, endoscopic retrograde cholangiopancreatography (ERCP), genetic mutations, trauma, surgery, infections and toxins, pregnancy, vascular disease, and drugs [4-6]. Although its occurrence is relatively rare, drug-induced pancreatitis has estimated incidence of 0.1% to 2% [7]. The true incidence of drug-induced pancreatitis is not known, as the evidence is mainly derived from case reports [7]. Additionally, it has been reported that 5% to 20% of pancreatic cases are idiopathic [6]. We describe a 48-year-old female with an extensive medical history who presents to urgent care with a three-day history of abdominal pain. She had no history of gallstones or alcohol use. She had been taking a combination of triamterene and hydrochlorothihazide for the past seven years and reported that her physician had recently increased her dosage because of uncontrolled blood pressure. Laboratory findings showed markedly elevated lipase and amylase and leukocytosis and radiographic imaging showed hepatomegaly with steatosis, but no evidence of cholelithiasis. Other causes of pancreatitis were considered. The patient received aggressive treatment with intravenous (IV) fluids, IV hydromorphone, placed on nothing by mouth (NPO) status, and hydrochlorothiazide was discontinued. Over the next 24 hours, the patient’s pain, leukocytosis, amylase, and ...