Azathioprine-associated Acute Pancreatitis in Rheumatoid Arthritis

Choi, Jong Won; Keum, Soo Mi; Park, Yong Beom; Park, Jin Hyung; Shin, Jae Uk; Kim, Ho Gak; Bae, Jyung Dong; Choe, Jung Yoon

Abstract

Drug-induced pancreatitis is now recognized as a distinct, although uncommon, entity. Azathioprine has been incriminated as a causative agent of acute pancreatitis. We report a 36-year-old female who developed acute pancreatitis in the course of treatment with azathioprine for rheumatoid arthritis. She was admitted due to epigastric pain, radiating to the back, for four days. Serum amylase and lipase levels were 226U/L (normal : 30-110U/L) and 1300U/L(normal : 23-300U/L), respectively. The abdominal ultrasonogram and CT scan revealed diffuse enlargement of the pancreas. We diagnosed it as acute pancreatitis. There was no history of alcohol use or gallbladder disease. We considered drugs, especially azathioprine, as the cause of acute pancreatitis. The patient was treated conservatively with intravenous fluid and analgesics. The symptoms subsided within three days. Thirteen days later, azathioprine was resumed. After six hours, the patient complained of epigastric pain. The elevated level of serum lipase(542U/L) confirmed the recurrence of pancreatitis. Her symptoms subsided when azathioprine intake stopped, and the serum lipase level returned to normal within four days.