Tigecycline
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Severe acute pancreatitis : case report A 68-year-old man developed severe acute pancreatitis during treatment with tigecycline for Mycobacterium abscessus lung infection. The man, who had chronic obstructive pulmonary disease, underwent a single right lung transplant at the age of 65 years. After 22 months, he underwent a left lung transplant due to chronic lung allograft dysfunction. Following the transplant, surveillance bronchoalveolar lavage (BAL) was positive for Mycobacterium abscessus. Then, he was treated with azithromycin, nebulised amikacin and tobramycin. After 2 months, surveillance bronchoscopy showed recurrence of Mycobacterium abscessus. Therefore, he started receiving IV tigecycline [dosage not stated] for eradication. However, he developed severe acute pancreatitis necessitating ICU admission and renal failure requiring dialysis [duration of treatment to reaction onset not stated]. The treatment with tigecycline was stopped. The man received maintenance therapy with azithromycin and amikacin. Subsequently, off-label clofazimine was added to his therapy. Despite treatment, he suffered from weight loss, persistent fevers, worsening weakness, cough, shortness of breath and increase hypoxemia. A CT scan of the chest demonstrated right-sided necrotising pneumonia. Bronchoscopy showed yellowish mucosa with areas of erythema. BAL revealed persistent Mycobacterium abscessus. He started receiving nebulised azithromycin. But, his condition did not improve. Despite treatment with clofazimine, azithromycin nebulised amikacin and azithromycin, he remained symptomatic with daily fevers. Chest imaging demonstrated worsening right-sided loculated effusion and multifocal pneumonia with necrosis. The man was hospitalised and was re-initiated on IV tigecycline and amikacin, following which he became afebrile. However, he again developed pancreatitis, and tigecycline therapy was discontinued. He was treated with unspecified opiates for pain control. Subsequently, he was intubated due to respiratory depression. Eventually, pancreatitis resolved, and he was extubated. He was extubated to comfort care alone. Eventually, he died [immediate cause of death not stated]. Raad S, et al. Lightning does strike twice: Tigecycline-induced pancreatitis and mycobacterium abscessus. American Journal of Respiratory and Critical Care Medicine 199: 803446260 abstr. A2036, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A2036 [abstract]
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Reactions 18 Jan 2020 No. 1787
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