Pugazhenthan Thangaraju, MD; Sajitha Venkatesan, MD
WMJ. 2024;123(3):156.
Dear Editor:
Kakes et al recently highlighted a case where pancreatitis was suspected to be caused by doxycycline.1 We appreciate the authors for highlighting this uncommon case and raising awareness about drug safety worldwide. Additionally, we have included some key points related to this circumstance.
The case report indicates that cephalexin was initiated to treat a surgical site infection and was taken for 4 days at a dosage of 500 mg 3 times daily. The patient was switched to a different antibiotic due to stomach discomfort. It is important to note that the initial adverse reaction experienced by the patient – stomach upset – could be attributed to gastritis or early signs of pancreatic injury. For example, a case reported by Alim et al mentions acute pancreatitis due to cephalexin in a 55-year-old female who took 500 mg of cephalexin preventively. She presented to the emergency department (ED) 3 hours later with sudden upper abdomen pain radiating to her back. Her lipase levels were 889 units/liter on initial tests.2 Afterward, she received doxycycline treatment for 10 days. Throughout the antibiotic regimen, ibuprofen 800 mg was taken intermittently for 7 days.
Additionally, aside from the author’s citations, several other cases provide strong evidence linking suspected ibuprofen use to the progression of pancreatic damage resulting in pancreatitis.3-5 It is evident that the first injury was caused by cephalexin, followed by continued injury from doxycycline and ibuprofen. According to the World Health Organization’s causality assessment, this is considered a possible case with events related to drug use over time. The reaction also could be influenced by illness or other medications, and details about drug withdrawal may be unclear. Further, this case has been classified as level 5 on Hartwig’s Severity Assessment Scale due to the need for intensive care and an extended hospital stay.
REFERENCES
- Kakes J, Cayley WE, Sporleder J. A case of doxycycline-induced pancreatitis. WMJ. 2024; 123(1):43-47.
- Alim H, Moustafa A, Eslam Y, et al. Acute pancreatitis due to cephalexin: a case report and review of literature: 2823. Am J Gastroenterol. 2017;112:S724-S725.
- Moslim MA, Sodeman TC, Nawras AT. A case of suggested ibuprofen-induced acute pancreatitis. Am J Ther. 2016;23(6):e1918-e1921. doi:10.1097/01.mjt.0000433943.93782.8a
- Bruusgaard-Mouritsen ME, Leerhøy B, Hansen MB. Akut pankreatitis hos en 16-årig dreng efter indtag af ibuprofen [Acute pancreatitis after ingestion of ibuprofen in a 16-year-old boy]. Article in Danish. Ugeskr Laeger. 2015;177(28):V12140671.
- Magill P, Ridgway PF, Conlon KC, Neary P. A case of probable ibuprofen-induced acute pancreatitis. JOP. 2006;7(3):311-314.