SHM Converge Scientific Abstract ePoster Gallery-A Rare Etiology of Pancreatitis and a Vigilant Medication Reconciliation

Pdf Summary

This case report highlights a rare cause of acute pancreatitis: trimethoprim-sulfamethoxazole (TMP-SMX). A 76-year-old woman with COPD on chronic prednisone and home oxygen presented with diffuse abdominal pain and nausea. Exam showed epigastric and lower abdominal tenderness. Laboratory studies revealed marked leukocytosis and elevated lipase (3000 U/L), while liver tests, calcium, triglycerides, and IgG-4 were not suggestive of common alternative causes. Ultrasound showed cholelithiasis without biliary obstruction, and CT imaging demonstrated inflammation of the pancreatic head and adjacent duodenum. Infectious evaluation was negative.<br /><br />Medication reconciliation uncovered that TMP-SMX had been started three weeks earlier for Pneumocystis jirovecii pneumonia prophylaxis while she was taking chronic prednisone. Given the timing and exclusion of other causes, TMP-SMX was suspected as the trigger for drug-induced acute pancreatitis. The drug was discontinued and replaced with atovaquone. The patient was treated supportively with IV fluids, pain control, and a proton pump inhibitor, and her symptoms improved. Follow-up imaging showed improvement in pancreatitis, and she was discharged with outpatient follow-up.<br /><br />The report emphasizes that drug-induced pancreatitis accounts for a small but important fraction of acute pancreatitis cases and can be difficult to diagnose because it is largely a diagnosis of exclusion. TMP-SMX is a widely used antibiotic and is known to cause several adverse effects, but pancreatitis is rare and not always recognized. The authors stress the importance of careful medication reconciliation when evaluating pancreatitis, as identifying the offending drug can prevent recurrence and guide safer future prophylaxis.

Asset Subtitle

Samantha Rubin

Meta Tag

Author List Nicholas Condiles, Peter Bhandari, Samantha Rubin

Category Clinical Vignettes

Concept Trimethoprim-sulfamethoxazole

Concept Drug-Induced Pancreatitis

Concept Acute Pancreatitis

Concept Medication Reconciliation

Concept Badalov Classification System

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Samantha Rubin

Track Adult

Keywords

acute pancreatitis

trimethoprim-sulfamethoxazole

TMP-SMX

drug-induced pancreatitis

Pneumocystis jirovecii prophylaxis

prednisone

lipase elevation

abdominal pain

medication reconciliation

atovaquone

Trimethoprim-sulfamethoxazole

Drug-Induced Pancreatitis

Acute Pancreatitis

Medication Reconciliation

Badalov Classification System