Loperamide-Induced Acute Pancreatitis

Acute pancreatitis is a common disease leading to hospitalizations, most often caused by gallstones or alcohol. We present a case of a patient diagnosed with acute pancreatitis considered to be due to loperamide treatment for diarrhea. 1. Case Report A 58-year-old woman with a history of hypertension, hypothyroidism, and cholecystectomy presented to the emergency department with a 7-day history of abdominal pain, nausea, and vomiting. The pain started after she began to take loperamide for diarrhea. She started having diarrhea 10 days before admission and took loperamide for two days, 10？mg on the first day and then 6？mg on the second day. Her daily medications were thyroxin, hydrochlorothiazide, and atenolol. She did not drink alcohol or smoke. At initial clinical examination, she had normal vital parameters (blood pressure, pulse, oxygen saturation, respiration rate, and temperature) and palpation tenderness in epigastrium. She had elevated lipase 2513？U/L (normal < 300？U/L) and amylase 124？U/L (normal < 120？U/L). WBC was 12,5？mmol/L and CRP was 63？mg/L. Hemoglobin, electrolytes, arterial blood gas, creatinine, urea, and liver functions tests including bilirubin were within normal limits. Abdominal CT scan showed the status after cholecystectomy and acute pancreatitis (Figure 1). MRCP showed the status after cholecystectomy, diameter of the common bile duct was 5？mm, and there were no signs of gallstones. Her calcium level was 2,22？mmol/L. Figure 1: A computed tomography scan at the day of admission showing pancreatitis changes. Loperamide was discontinued, her condition improved rapidly, and she was discharged three days after her admission. The patient has not suffered further attacks of pancreatitis and is doing well approximately 12 months after her hospitalization. 2. Discussion Acute pancreatitis is a common disease leading to hospitalization, with incidence figures ranging from 14.6 to 32 per 100.000 [1, 2]. In most series, the vast majority of patients have gallstones- or alcohol-induced pancreatitis. Drug-induced pancreatitis is relatively rare [3]; however, 525 different drugs are listed in the World Health Organization (WHO) database suspected to cause acute pancreatitis as a side effect. Many of them are widely used to treat highly prevalent diseases. The true incidence is not entirely clear since only few systematic population-based studies exist [4]. In a recent cohort study, 3,4% of the patients had drug-induced pancreatitis [3]. Some drugs have pancreatitis documented as a side effect such as azathioprine [5], and opiates have also