Šmaguc Ana, Mačković Maja, Marić Nikolina, Udiljak Nikola
Department of Clinical Immunology, Rheumatology and Pulmonology, Clinical Hospital Sveti Duh, Zagreb, Croatia.
Intensive care unit, Clinical Hospital Sveti Duh, Zagreb, Croatia.
Eur J Case Rep Intern Med. 2025 Jul 23;12(9):005619. doi: 10.12890/2025_005619. eCollection 2025.
Tacrolimus is a commonly used immunosuppressant with well-defined side effects, including hypertriglyceridemia and hyperglycaemia. However, acute pancreatitis is still not widely recognized as an adverse event related to tacrolimus.
A 60-year-old male was admitted to the intensive care unit with symptoms and signs of acute pancreatitis. He underwent lung transplantation 4 years ago and since then received tacrolimus, mycophenolate mofetil (MMF) and prednisone. His initial laboratory tests revealed elevated serum amylase and lipase, high inflammatory parameters, markedly elevated triglycerides and hyperglycemia with diabetic ketoacidosis. He was treated with continuous insulin infusion, electrolyte correction, crystalloid titration and antimicrobial therapy. During the fasting period, immunosuppression was maintained with parenteral methylprednisolone and tacrolimus. Gradually, oral tacrolimus, MMF and full enteral nutrition were introduced. A control computed tomography scan showed pancreatic body necrosis with a large pseudocyst. The patient was discharged on a strict diet, fenofibrate and short- and long-acting insulin. Immunosuppressive therapy with tacrolimus, MMF and prednisone was continued. He was hospitalized several times within a year due to complications of severe necrotizing pancreatitis.
Acute pancreatitis associated with the use of tacrolimus is rare. Factors contributing to its occurrence are longer exposure period, toxic levels of the drug and concurrent metabolic derangements, predominantly hypertriglyceridemia. In this case report we present a patient after lung transplantation on tacrolimus therapy who developed severe acute necrotizing pancreatitis along with hypertriglyceridemia and diabetes mellitus. We also conducted a literature search and found 13 other cases of acute pancreatitis presumably related to tacrolimus therapy.
Tacrolimus related complications including metabolic changes are commonly observed.Development of acute pancreatitis is one of the rare complications of tacrolimus therapy, seldomly reported in transplant recipients.The definitive therapeutic approach is still to be determined.
他克莫司是一种常用的免疫抑制剂，其副作用明确，包括高甘油三酯血症和高血糖症。然而，急性胰腺炎仍未被广泛认为是与他克莫司相关的不良事件。
一名60岁男性因急性胰腺炎的症状和体征入住重症监护病房。他4年前接受了肺移植，此后一直服用他克莫司、霉酚酸酯（MMF）和泼尼松。他最初的实验室检查显示血清淀粉酶和脂肪酶升高、炎症参数升高、甘油三酯显著升高以及糖尿病酮症酸中毒伴高血糖。他接受了持续胰岛素输注、电解质纠正、晶体液滴定和抗菌治疗。在禁食期间，通过静脉注射甲泼尼龙和他克莫司维持免疫抑制。逐渐地，引入了口服他克莫司、MMF和全肠内营养。对照计算机断层扫描显示胰体坏死并伴有一个大的假性囊肿。患者出院时遵循严格饮食，服用非诺贝特以及短效和长效胰岛素。继续使用他克莫司、MMF和泼尼松进行免疫抑制治疗。由于严重坏死性胰腺炎的并发症，他在一年内多次住院。
与使用他克莫司相关的急性胰腺炎很罕见。其发生的因素包括暴露时间较长、药物毒性水平以及并发的代谢紊乱，主要是高甘油三酯血症。在本病例报告中，我们介绍了一名接受他克莫司治疗的肺移植患者，该患者发生了严重的急性坏死性胰腺炎以及高甘油三酯血症和糖尿病。我们还进行了文献检索，发现了另外13例可能与他克莫司治疗相关的急性胰腺炎病例。
他克莫司相关并发症包括代谢变化很常见。急性胰腺炎的发生是他克莫司治疗罕见的并发症之一，在移植受者中很少报道。确切的治疗方法仍有待确定。
