Chambers Ethan K, Stratulat Eugeniu, Judge Gurjeet, Shafique Seaf, Ladel Luisa
Internal Medicine, Norwalk Hospital, Norwalk, USA.
Cureus. 2023 Feb 27;15(2):e35554. doi: 10.7759/cureus.35554. eCollection 2023 Feb.
As a first-line immunosuppressant to maintain remission in Crohn's disease, 6-mercaptopurine (6-MP) has been commonly used. A rare, unpredictable, dose-independent and idiosyncratic reaction to this medication is acute pancreatitis. Unlike other side effects of this drug which have been well characterized and are often dose-dependent, acute pancreatitis is an uncommon adverse effect not frequently encountered in clinical practice. In this case report, we describe a 40-year-old man with Crohn's disease who developed acute pancreatitis within two weeks of starting 6-MP. Discontinuation of the drug followed by fluid resuscitation led to the overall improvement of symptoms within 72 hours. No complications were noted during the follow-up. It is our intention to raise awareness for this lesser-known side effect with this case report and to urge physicians to provide thorough counseling prior to starting on this medication, especially in patients with inflammatory bowel disease (IBD). Additionally, we hope to reinforce this disease entity as a differential for acute pancreatitis and aim to emphasize the importance of detailed medication reconciliations with this report, especially in the emergency department, to enable quick diagnoses and limit unnecessary treatments.
作为维持克罗恩病缓解的一线免疫抑制剂，6-巯基嘌呤（6-MP）已被广泛使用。这种药物罕见、不可预测、与剂量无关的特异反应是急性胰腺炎。与该药物其他已得到充分描述且通常与剂量相关的副作用不同，急性胰腺炎是一种在临床实践中不常遇到的罕见不良反应。在本病例报告中，我们描述了一名40岁的克罗恩病男性患者，在开始使用6-MP两周内发生了急性胰腺炎。停药并进行液体复苏后，症状在72小时内总体得到改善。随访期间未发现并发症。我们希望通过本病例报告提高对这种鲜为人知的副作用的认识，并敦促医生在开始使用这种药物之前提供全面的咨询，尤其是对于炎症性肠病（IBD）患者。此外，我们希望强化将这种疾病实体作为急性胰腺炎的鉴别诊断，并旨在通过本报告强调详细药物核对的重要性，尤其是在急诊科，以便能够快速诊断并减少不必要的治疗。
