Abstract
Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification.
Highlights
The long-term outcome of acute lymphoblastic leukemia (ALL) has improved dramatically during the last few decades because of the development of well-designed and effective treatment protocols
We report a case of a 16-year-old male patient who developed transient diabetes mellitus following L-asparaginase therapy with ketoacidosis and acute pancreatitis as the mode of presentation
After three days of fluid correction, insulin infusion, fasting, and analgesic therapy, the patient was discharged presenting no further complications. This case represents a combination of two rare complications related to L-asparaginase treatment during the remission induction phase of treatment in a patient with ALL
Summary
The long-term outcome of acute lymphoblastic leukemia (ALL) has improved dramatically during the last few decades because of the development of well-designed and effective treatment protocols. Since 1961, L-asparaginase, combined with danorubicin, vincristine, and prednisone, the cornerstone treatment for ALL. They are used in remission, induction, and intensification phases in all pediatric regimens and in the majority of adult treatment protocols [1, 2]. Acute pancreatitis (AP), hyperglycemia, and diabetic ketoacidosis (DKA) can be present [4] Even though these side effects are well known, the combination of both DKA and AP represents unusual conditions generally reported as benign and self-limited [5]. We report a case of a 16-year-old male patient who developed transient diabetes mellitus following L-asparaginase therapy with ketoacidosis and acute pancreatitis as the mode of presentation
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