Case reportMefenamic acid: A possible cause of drug-induced acute pancreatitis
Introduction
Drug-induced acute pancreatitis (AP) is rare, reported to be 0.1–5.3% of all AP episodes [1], [2], [3], [4], though due to the lack of systematic data, the true incidence is unknown and evidence has mainly been derived from case reports and case series [5], [6]. Since drug-induced AP has no characteristic clinical course, it cannot be differentiated from other forms of AP on that basis alone. Criteria for drug-induced AP were defined 35 years ago by Mallory and Kern [7]. The number of drugs associated to AP varies from 120 to 500 [6], [8], and widely varying potencies of certain substances are reported to induce AP [8].
This case report is a first description of two episodes of AP occurring after administration and subsequent re-administration of mefenamic acid (latency of AP from drug ingestion <24 h for both episodes) to a patient without comorbidities. Other causes of AP could be ruled out systematically.
Section snippets
Case report
A 16-year-old girl with a medical history of recurrent constipation presented to the emergency department with severe abdominal pain and emesis in the evening. The symptoms had developed a few hours after oral intake of mefenamic acid, 500 mg, for the first time in her life for a severe headache at midday. No other concomitant medications were taken and no alcohol abuse was reported. Physical examination upon admission revealed abdominal tenderness but no guarding. Laboratory findings showed
Discussion
The most common causes of AP in developed countries are biliary disease (38%) or alcoholism (36%) [3].
AP induced by drugs is a rare entity that presents a diagnostic challenge, as it has no definite clinical characteristics to distinguish it from other forms of AP [7], [8], [9], [10]. Drug-induced AP was first described by Mallory and Kern in 1980 [7]. That publication postulated a key point for identifying AP as drug-induced: the development of AP after intake of the drug AND its reappearance
Source of funding
None.
Disclosure statement
The authors report nothing to disclose.
Acknowledgements
We thank Dr. Herbert Ringhofer, MD for his technical support with respect to the images presented.
We thankfully appreciate the editorial assistance provided by Eugenia Lamont, BA.
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