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Acute pancreatitis: 2 case reports Two patients developed acute pancreatitis during treatment with thioprine drugs for inflammatory bowel disease [dosages and times to reaction onset not stated]. A 25-year-old man with Crohn’s disease received oral azathioprine following failure to maintain disease remission with infliximab. Approximately 3 weeks after initiation he developed a fever, arthralgia and pain in his upper limbs. Laboratory results revealed a slightly elevated serum amylase level. A CT scan showed slight pancreas enlargement. Azathioprine was suspended and his symptoms improved 2 days later. After 7 days, azathioprine was reintroduced but the following day he again experienced fever and upper abdominal pain. Repeat laboratory tests showed marked leukocytosis and elevated levels of amylase and lipase. A CT scan showed diffuse pancreatic enlargement. Azathioprine was discontinued under suspicion of drug-induced acute pancreatitis. The following day his symptoms had virtually disappeared. A 13-year-old boy with steroid-dependent ulcerative colitis received azathioprine [route not stated] for maintenance of disease remission. Approximately 3 weeks after starting azathioprine he experienced bloody faeces accompanied by abdominal pain and fever. Laboratory results on admission 1 week later showed leukocytosis and an elevated CRP but a normal amylase level. Antibiotics were administered but his symptoms did not improve. His serum amylase level subsequently increased and druginduced pancreatitis was suspected. Azathioprine was discontinued and the following day his fever and abdominal pain had disappeared. Mercaptopurine [route not stated] was subsequently introduced but the day following initiation his abdominal pain and fever reappeared and serum amylase level increased. A CT scan revealed enlargement of the pancreas. Drug-induced acute pancreatitis was again suspected and mercaptopurine was discontinued. The following day his fever and abdominal pain had disappeared. Author comment: We experienced 2 cases of inflammatory bowel disease in which acute pancreatitis was brought about through the administration of thiopurine formulations. Nishikawa J, et al. Two cases of thiopurine-induced acute pancreatitis in inflammatory bowel disease. Nihon Shokakibyo Gakkai Zasshi / Japanese Journal of Gastroenterology 109: 224-230, No. 2, Feb 2012 [Japanese; summarised from a 803075257 translation] - Japan

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Reactions 11 Aug 2012 No. 1414