Acute pancreatitis is a common cause of hospital admission; however, cases secondary to medication use are rare. We report a case of drug-induced mild acute pancreatitis in a 33-year-old female with type 2 diabetes mellitus. The patient presented with a one-day history of vomiting and lower chest and epigastric pain after five months of starting sitagliptin therapy. She was also taking the combined oral contraceptive pill. Clinical examination revealed epigastric tenderness and signs of dehydration. Laboratory findings showed elevated white cell count, C-reactive protein, and triglyceride levels. Although the serum amylase level was not clinically significant, a contrast-enhanced computed tomography performed 24 hours after the onset of symptoms demonstrated pancreatic inflammation and peri-pancreatic fluid consistent with acute pancreatitis. Common etiologies, including gallstones and alcohol, were excluded through imaging and history. The patient was managed conservatively with intravenous fluids for hydration and intravenous insulin for the severe hypertriglyceridemia and ketoacidosis. Sitagliptin was discontinued and replaced with gliclazide as opposed to metformin, which she was intolerant to. The combined oral contraceptive pill was continued. She demonstrated gradual improvement with normalization of inflammatory markers and triglyceride levels, achieving full recovery by day five. This case highlights the importance of considering sitagliptin and other medications, such as the combined oral contraceptive pill, as potential causes of acute pancreatitis and emphasizes the need for early recognition and prompt discontinuation of the offending agent to ensure optimal outcomes in patients.
Ruwanpathiranage et al. (Sat,) studied this question.