Doxycycline-Induced Pancreatitis

Abstract

Introduction: A 49-year-old man presented to the emergency department with complaints of 2-day history of abdominal pain without any significant nausea, vomiting, diarrhea, or constipation. He was started on doxycycline 100 mg twice daily for tooth infection 5 days ago. Physical examination showed abdominal distention and epigastric tenderness without guarding. Past medical history included, seizures, and COPD. Home medications were pantoprazole, phenobarbital, and tegretol. Labs were significant for mild leukocytosis, hemoglobin of 11, and hematocrit of 34, and metabolic profile showed normal aspartate transaminase, alanine transaminase, alkaline phosphatase, amylase, lipase, and normal lipid profile. Abdominal ultrasound did not show any gallstones, but CT abdomen with contrast showed pancreatitis with peripancreatic fluid. Doxycycline was discontinued and patient was started on intravenous fluids, pain control, and tube feedings. Patient’s symptoms have significantly improved and he was able to tolerate oral feedings. Patient was discharged after uncomplicated course and was told not to take doxycycline again. Drug-induced pancreatitis represents 1.4% of all causes of acute pancreatitis. Diagnostic criteria include: pancreatitis develops during drug therapy, other possible causes of pancreatitis should be eliminated, pancreatitis should resolve after discontinuing the suspected drug, and the reoccurrence of pancreatitis after reusing the same drug. Drug-induced pancreatitis classified into definite, highly probable, or weakly probable in correlation with mentioned criteria. Our patient developed acute pancreatitis 3 days after the administration of doxycycline and was resolved 3 days after discontinuation of the drugs. All other possible factors, such as alcohol use, gallstones, hypercalcemia, hyperlipidemia, and malignancy were eliminated by physical examination, blood tests, and imaging studies. Adverse effects of doxycycline include elevation of liver and renal function tests, nausea, vomiting, and dysphagia. Doxycycline is part of the tetracycline group of antibiotics, which is linked to few cases of acute pancreatitis. Suggested theories include intrinsic toxins versus idiosyncratic reactions. Our patient most likely suffered from acute pancreatitis due to doxycycline since other causes of pancreatitis were eliminated. Although this adverse effect is not well known, it is probably quite rare. Physicians should consider acute pancreatitis in patients who develop nausea, vomiting, and epigastric pain when taking doxycycline. If doxycycline is suspected as the causative agent, it should be discontinued and readministration should be avoided.