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Fatal pancreatitis: case report A 68-year-old woman developed fatal pancreatitis during chemotherapy with cyclophosphamide and epirubicin for stage III invasive right breast carcinoma. The woman was admitted with fever with chills with severe, diffuse abdominal pain, nausea, vomiting and diarrhoea, for the past 24 hours. She had multiple cardiovascular comorbidities. Three months prior to this admission, she was diagnosed with stage III invasive right breast carcinoma, for which she had started receiving cycles of epirubicin 100 mg/m2 and cyclophosphamide 600 mg/m2 [routes not stated]. Ten days prior to this admission, she had received the second cycle of cyclophosphamide and epirubicin. Lab results revealed leucopenia and neutropenia. Also, she had mild hypopotassaemia and markedly elevated serum amylase level. A contrast enhanced-CT scan demonstrated an enhancement and oedema of the pancreas along with mild surrounding fatty infiltrations, along with bilateral paracolic fluid collections, and peri-pancreatic and omental bursa. Therefore, the woman started receiving unspecified IV fluid hydration along with unspecified analgesics, antiemetic and antispastics. She was kept on nill by mouth (nil per os). She started receiving ciprofloxacin and meropenem as antibacterials along with unspecified antifungals. Also, she was treated with filgrastim for severe leucopenia. On hospital day 3, she developed Clostridium difficile infection, for which she was treated with metronidazole [metronidazol] and vancomycin [vancomicine]. However, on hospital day 10, the haemodynamic and clinical status worsened. A contrast-enhanced CT-scan revealed pleural effusion, large peri-pancreatic encapsulated fluid collections and massive pancreatic necrosis. She was moved to the ICU due to severe haemodynamic instability. Subsequently, she developed metabolic acidosis, septic shock, severe electrolyte imbalance and acute renal failure. She received unspecified positive inotropic treatment and plasma volume expanders; however, she developed an hypotensive/bradycardic episode, which led to asystole (asistoly) without any response to resuscitation maneuvers. Based on the investigations and clinical presentation, chemotherapy (cyclophosphamide and epirubicin)-induced severe acute pancreatitis was determined, which rapidly evolved into death. Adina R, et al. Chemotherapy-induced severe acute pancreatitis - A case report. Journal of Gastrointestinal and Liver Diseases 28 (Suppl. 2): 43-44 abstr. PP 18, 2019. 803497664 Available from: URL: https://www.jgld.ro/jgld/index.php/jgld/supplements [abstract]

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Reactions 22 Aug 2020 No. 1818