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Acute pancreatitis: case report A 24-year-old man developed acute pancreatitis during immunosuppressive treatment with methylprednisolone, and following concomitant administration of tacrolimus and tigecycline [duration of treatments to reaction onsets not stated]. The man, who had a history of end-stage renal disease due to chronic glomerulonephritis since two years, underwent a kidney transplantation in November 2018. He was treated with peritoneal dialysis for two years. Before transplantation, he had received basiliximab and unspecified corticosteroids. The transplantation was successful, and he was started on an initial immunosuppressive regimen comprising oral tacrolimus 4 mg/day on day 3 after transplant and methylprednisolone [not all dosages and routes stated] along with mycophenolate sodium. He was also administered caspofungin and meropenem to prevent postoperative infections. On day 3 after the transplantation, he started receiving IV tigecycline 200mg (first dose) followed by 100mg every 12 hours because of development of Escherichia coli in the organ preservation solution and Enterococcus faecium in the donor graft. On day 5 after the transplantation, tacrolimus was temporarily stopped due to high trough concentration of tacrolimus than the assay limits (>30 ng/mL). Physical examination performed between day 5 and day 9 showed moderate abdominal tenderness. He then presented with a diarrhoea. Laboratory results showed WBC ranging from 5.14–8.59 × 109 /L, whereas transaminase levels were within normal range. On day 9, his diarrhoea was persistent and his rumbling sound weakened. Plain abdominal X-ray showed ileus. On day 10, he presented with abdominal pain, particularly in the epigastric region, flatulence, diarrhoea along with vomiting and nausea. Physical examination showed diffuse abdominal tenderness and diminishing bowel sound. Laboratory tests showed Hb 96 g/L, WBC count 10.96 × 109 /L, platelet count 84 × 109 /L, ALT 135 U/L, AST 85.6 U/L, lipase level 728.8 U/L and serum amylase level 512.5 IU/L. An abdominal CT scan showed large-volume ascites and pelvic cavity effusion. The abdominal drainage fluid levels of amylase were 1750.3 IU/L. Based on these findings, a diagnosis was confirmed with acute pancreatitis. The pharmacokinetic interaction between tigecycline and tacrolimus led to high serum concentrations of tacrolimus, which caused acute pancreatitis. Additionally, methylprednisolone contributed to acute pancreatitis. The man’s treatment with tigecycline and mycophenolate sodium was stopped. He was treated with somatostatin, IV fluids and unspecified antibacterial drugs. On day 11, decreased lipase and amylase levels were noted. Tacrolimus was not administered for another 4 days, and was re-initiated at a reduced dose of 0.5mg twice daily along with mycophenolate sodium. On day 14, after taking tacrolimus, he presented with vomiting, severe abdominal pain and nausea. Therefore, he was switched from oral tacrolimus to ciclosporin. After 12 days of starting somatostatin (day 22 after t