Pancreatitis in adult with acute lymphoblastic leukemia using L-asparaginase and simvastatin: case report and systematic review

Renne Rodrigues,Diogo D Gavarrete,Érika A T Bernardi,Eduardo C Munhoz

doi:10.11606/issn.2176-7262.v49i1p90-94

Abstract

Context: Acute pancreatitis is a inflammatory process of the pancreas. It can be caused by gallstones, metabolic disorders, associated or not with alcohol abuse, or medication. Case Report: A 38-year-old man was admitted to the hospital because of worsening of nausea, abdominal pain, dizziness and white stool. Patient was diagnosed with severe acute pancreatitis. After six days of hospitalization, patient progressed into hypotension and severe bradycardia, and died. The patient used simvastatin chronically, and was in treat with L-asparaginase, both drugs related to the occurence of acute pancreatitis separately. Naranjo´s probability scale of adverse drug reaction established the causality between these medications and acute pancreatitis as probable. However, due to the absence of reports of causality, the acute pancreatitis is associated with to the use of L-asparaginase with possible drug interactions with simvastatin. Conclusion: It is very important to monitor patients treated with L-asparaginase, through careful observation of clinical signs and laboratory follow-up, as well as verification of other medications in use. The AP may have different levels of severity, being indispensable the quick diagnosis and early treatment

Highlights

Acute pancreatitis is an inflammatory process of the pancreas, usually reversible
The clinical diagnosis of acute pancreatitis is based on characteristic abdominal pain and nausea, combined with elevated serum levels of pancreatic enzymes and abdominal imaging by computed tomography (CT), magnetic resonance imaging, or transabdominal ultrasonography.[2]
Exams performed in the emergency lab showed abnormal levels of amylase, lipase, lactate dehydrogenase (LDH), Creactive protein (CRP) and total bilirubin (Table 1), and the patient was admitted with suspected pancreatitis

Summary

Introduction

Acute pancreatitis is an inflammatory process of the pancreas, usually reversible. It can be caused by gallstones, metabolic disorders, associated or not with alcohol abuse, or medication.[1,2] The clinical diagnosis of acute pancreatitis is based on characteristic abdominal pain and nausea, combined with elevated serum levels of pancreatic enzymes (amylase and lipase) and abdominal imaging by computed tomography (CT), magnetic resonance imaging, or transabdominal ultrasonography.[2]. Exams performed in the emergency lab showed abnormal levels of amylase, lipase, lactate dehydrogenase (LDH), Creactive protein (CRP) and total bilirubin (Table 1), and the patient was admitted with suspected pancreatitis. Differential diagnosis confirmed the hypothesis of Acute Pancreatitis (AP), discarding hypertriglyceridemia, alcohol and gallstones as causative agents This cause was associated with medications, L-asparaginase with possible participation of simvastatin. On 5th day of hospitalization, there was an improvement of amylase and LDH, but there was a rise of CRP (Table 1), associated with clinical suspicion of infection. For this reason antibiotic treatment (meropenem) was started. In the morning of 6th day of hospitalization, patient progressed into hypotension, severe bradycardia, and died

Discussion

Review

Conclusion