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Recurrent acute pancreatitis: case report An approximately 30-year-old man developed recurrent acute pancreatitis (AP) during treatment with mesalazine and azathioprine [not all routes and dosages stated] for ulcerative colitis (UC). The man presented at 31 years of age, in 2019, with a 3 day history of intermittent colic epigastric abdominal pain, nausea, vomiting and bloody diarrhoea. He had been diagnosed with left-sided UC in 2018, and had been receiving treatment with oral azathioprine 150 mg/day from June 2019. Before the presentation, in October 2018, he had received mesalazine [5-ASA] and had developed drug-induced acute pancreatitis and drug was stopped in November 2018; the Naranjo scale score was 7. At the current presentation, based on the presentation, a diagnosis of UC flare along with recurrence of AP was suspected. His serum lipase and amylase activity was significantly high and findings of transabdominal ultrasonography and contrast-enhanced CT were suggestive of AP, hence confirming a diagnosis of recurrent AP. He was admitted. Upon admission, he showed normal cardiopulmonary result and normal haemoglobin. His AP severity was rated as 2. The man was treated with IV fluid replacement and underwent insertion of a nasogastric tube. Alcoholic and biliary origins as causes of AP were excluded. Hence, a diagnosis of azathioprine-induced AP was considered. Azathioprine was discontinued in July 2019. Following treatment, his condition improved and he was noted to be asymptomatic on day 4 of admission. The amylase and lipase levels decreased. After recovery, a re-challenge of azathioprine was considered, as he wished to continue the therapy. The man was re-challenged with oral azathioprine 50mg daily. However, within 6 hrs of the re-administration, he developed abdominal pain (8/10), vomiting, nausea and elevated pancreatic enzymes. Based on the results, a positive challenge for AP was considered. He was re-initiated on fluid replacement and enteral feeding. His clinical condition improved within 3 days, as did his laboratory markers, and he was eventually started on oral feeding with a carbohydrate-rich diet, followed by a regular diet 3 days later. Owing to a negative stool culture, his UC was treated with metronidazole and methylprednisolone, resulting in an improvement in his condition. He was discharged and metronidazole was continued, whereas methylprednisolone was tapered. Further use of mesalazine and azathioprine was contraindicated. Hegyi PJ, et al. Recurrent acute pancreatitis induced by 5-ASA and azathioprine in ulcerative colitis. Pancreatology : Oct 2020. Available from: URL: http://doi.org/10.1016/ 803517396 j.pan.2020.10.026

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Reactions 28 Nov 2020 No. 1832