A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis

Jeat Thong Tang; Azmad Kareem Anwardeen; Nur Hidayah Mohd Makhatar; James Emmanuel; Kunji Kannan Sivaraman Kannan

doi:doi:10.11648/j.ijidt.20210604.15

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A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis

Jeat Thong Tang, Azmad Kareem Anwardeen, Nur Hidayah Mohd Makhatar, James Emmanuel, Kunji Kannan Sivaraman Kannan

Published in International Journal of Infectious Diseases and Therapy (Volume 6, Issue 4)

Received: 6 October 2021 Accepted: 25 October 2021 Published: 30 October 2021

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Abstract

Background: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. Case Report: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to re-challenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. Conclusion: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.

Published in	International Journal of Infectious Diseases and Therapy (Volume 6, Issue 4)
DOI	10.11648/j.ijidt.20210604.15
Page(s)	153-156
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Drug Induced Pancreatitis, Rifampicin, Tuberculosis, Withdrawal, Infectious Disease

References

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[2]	Chadalavada, Pravallika; Mohammed, Abdul; Simons-Linares, Carlos Roberto; Chahal, Prabhleen. Drug Induced Pancreatitis: Prevalence, Causative Agents, and Outcomes, The American Journal of Gastroenterology: October 2020 - Volume 115 - Issue - p S66-S67.
[3]	Gubergrits N, Klotchkov A, Lukashevic G, Maisonneuve P. The Risk of Contracting Drug Induced Pancreatitis during Treatment for Pulmonary Tuberculosis. JOP Journal of the Pancreas April 2015.
[4]	Jones MR, Hall OM, Kaye AM, Kaye AD. Drug-induced acute pancreatitis: a review. Ochsner J. 2015 Spring; 15 (1): 45-51. [PMID: 25829880; PMCID: PMC4365846].
[5]	Chow KM, Szeto CC, Leung CB, Li PK. Recurrent acute pancreatitis after isoniazid. Neth J Med. 2004 May; 62 (5): 172-4. [PMID: 15366703].
[6]	Neila Fathallah, Raoudha Slim, Sofien Larif, Houssem Hmouda, Jaballah Sakhri, Cha ker Ben Salem. Drug-Induced Acute Pancreatitis Confirmed by Positive Re- challenge. Pancreatic Disorder & Therapeutic, Sep 30, 2015.
[7]	Tenner S. Drug induced acute pancreatitis: does it exist? World J Gastroenterol. 2014 Nov 28; 20 (44): 16529-34. [PMID: 25469020; PMCID: PMC4248195].
[8]	Treatment of tuberculosis: guidelines – 4th ed. Geneva, World Health Organization, 2010.
[9]	Mattioni S, Zamy M, Mechai F, Raynaud JJ, Chabrol A, Aflalo V, Biour M, Bouchaud O. Isoniazid-induced recurrent pancreatitis. JOP. Journal of the Pancreas. 2012 May 10; 13 (3): 314-6.
[10]	Chan TY. Isoniazid and rifampicin rarely cause acute pancreatitis in patients with tuberculosis. Int J Clin Pharmacol Ther. 1999 Feb; 37 (2): 109. [PMID: 10082175].
[11]	Michelle May D. Goroh, Giri Shan Rajahram, Richard Avoi, Christel H. A. Van Den Boogaard, Timothy William, Anna P. Ralph, and Christopher Lowbridge. Epidemiology of tuberculosis in Sabah, Malaysia, 2012–2018. Infect Dis Poverty. 2020; 9: 119. [PMID: 32843089].
[12]	Nitsche C, Maertin S, Schreiber J, Ritter CA, Lerch MM, Mayerle J. Drug-induced pancreatitis. Curr Gastroenterol Rep 2012; 14: 131-138. [PMID: 22314811].
[13]	Nison Badalov, Robin Baradarian, Kadirawel Iswara, Jianjun Li, William Steinberg, Scott Tenner. Drug-Induced Acute Pancreatitis: An Evidence-Based Review. Clinical Gastroenterology and Hepatology 2007; 5: 648–661.
[14]	Sherman S, Freeman ML, Tarnasky PR, Wilcox CM, Kulkarni A, Aisen AM, Jacoby D, Kozarek RA. Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology. 2014 Sep 1; 147 (3): 646-54.
[15]	Chamokova B, Bastati N, Poetter-Lang S, Bican Y, Hodge JC, Schindl M, Matos C, Ba-Ssalamah A. The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases. Br J Radiol. 2018 Apr; 91 (1084): 20170677. [PMID: 29206061; PMCID: PMC5966000].
[16]	Leo Lee Tsai, Karen Sisi Lee, Dynamic pancreatography with secretin-MRCP. Applied Radiology. May 2015.

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APA Style

Jeat Thong Tang, Azmad Kareem Anwardeen, Nur Hidayah Mohd Makhatar, James Emmanuel, Kunji Kannan Sivaraman Kannan. (2021). A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. International Journal of Infectious Diseases and Therapy, 6(4), 153-156. https://doi.org/10.11648/j.ijidt.20210604.15

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ACS Style

Jeat Thong Tang; Azmad Kareem Anwardeen; Nur Hidayah Mohd Makhatar; James Emmanuel; Kunji Kannan Sivaraman Kannan. A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. Int. J. Infect. Dis. Ther. 2021, 6(4), 153-156. doi: 10.11648/j.ijidt.20210604.15

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AMA Style

Jeat Thong Tang, Azmad Kareem Anwardeen, Nur Hidayah Mohd Makhatar, James Emmanuel, Kunji Kannan Sivaraman Kannan. A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. Int J Infect Dis Ther. 2021;6(4):153-156. doi: 10.11648/j.ijidt.20210604.15

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@article{10.11648/j.ijidt.20210604.15,
  author = {Jeat Thong Tang and Azmad Kareem Anwardeen and Nur Hidayah Mohd Makhatar and James Emmanuel and Kunji Kannan Sivaraman Kannan},
  title = {A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {6},
  number = {4},
  pages = {153-156},
  doi = {10.11648/j.ijidt.20210604.15},
  url = {https://doi.org/10.11648/j.ijidt.20210604.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20210604.15},
  abstract = {Background: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. Case Report: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to re-challenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. Conclusion: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.},
 year = {2021}
}

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TY - JOUR
T1 - A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis
AU - Jeat Thong Tang
AU - Azmad Kareem Anwardeen
AU - Nur Hidayah Mohd Makhatar
AU - James Emmanuel
AU - Kunji Kannan Sivaraman Kannan
Y1 - 2021/10/30
PY - 2021
N1 - https://doi.org/10.11648/j.ijidt.20210604.15
DO - 10.11648/j.ijidt.20210604.15
T2 - International Journal of Infectious Diseases and Therapy
JF - International Journal of Infectious Diseases and Therapy
JO - International Journal of Infectious Diseases and Therapy
SP - 153
EP - 156
PB - Science Publishing Group
SN - 2578-966X
UR - https://doi.org/10.11648/j.ijidt.20210604.15
AB - Background: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. Case Report: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to re-challenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. Conclusion: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.
VL - 6
IS - 4
ER -

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Author Information

Jeat Thong Tang

Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
Azmad Kareem Anwardeen

Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
Nur Hidayah Mohd Makhatar

Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
James Emmanuel

Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
Kunji Kannan Sivaraman Kannan

Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

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Plain Text BibTeX RIS

APA Style

Jeat Thong Tang, Azmad Kareem Anwardeen, Nur Hidayah Mohd Makhatar, James Emmanuel, Kunji Kannan Sivaraman Kannan. (2021). A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. International Journal of Infectious Diseases and Therapy, 6(4), 153-156. https://doi.org/10.11648/j.ijidt.20210604.15

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ACS Style

Jeat Thong Tang; Azmad Kareem Anwardeen; Nur Hidayah Mohd Makhatar; James Emmanuel; Kunji Kannan Sivaraman Kannan. A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. Int. J. Infect. Dis. Ther. 2021, 6(4), 153-156. doi: 10.11648/j.ijidt.20210604.15

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AMA Style

Jeat Thong Tang, Azmad Kareem Anwardeen, Nur Hidayah Mohd Makhatar, James Emmanuel, Kunji Kannan Sivaraman Kannan. A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis. Int J Infect Dis Ther. 2021;6(4):153-156. doi: 10.11648/j.ijidt.20210604.15

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@article{10.11648/j.ijidt.20210604.15,
  author = {Jeat Thong Tang and Azmad Kareem Anwardeen and Nur Hidayah Mohd Makhatar and James Emmanuel and Kunji Kannan Sivaraman Kannan},
  title = {A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {6},
  number = {4},
  pages = {153-156},
  doi = {10.11648/j.ijidt.20210604.15},
  url = {https://doi.org/10.11648/j.ijidt.20210604.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20210604.15},
  abstract = {Background: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. Case Report: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to re-challenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. Conclusion: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.},
 year = {2021}
}

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