Background
Case presentation
Relevant Past Medical History and Interventions | ||
Past medical history significant for hypothyroidism. Patient received amoxicillin/clavulanic acid as prophylaxis for a dental procedure (even though not indicated at that time) with dosage of 875 mg twice daily for a total of 10 days with his symptoms starting on day 9th of therapy prior to presentation. Several years ago, he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. | ||
Summaries from Initial and Follow-up Visits | Diagnostic Testing | Interventions |
Based on clinical presentation and CT findings, patient was diagnosed with mild acute pancreatitis with Bedside Index of Severity in Acute Pancreatitis (BISAP) score of 0 (< 1% risk of mortality), which is characterized by the absence of organ failure and local or systemic complications. During his hospital stay, patient was managed with aggressive IV hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h after which patient was discharged home. | Laboratory studies: WBC, amylase, lipase, and CRP. | Discontinuation of offending drug (amoxicillin/clavulanic acid); aggressive IV hydration and pain management with bowel rest of 2 days duration. |
No follow-up visits needed | Imaging: Abdominal CT, MRCP, abdominal ultrasound, and endoscopic ultrasonography. |
Discussion and conclusions
Case | Patient | Findings | Drug | Delay between introduction of the drug and pancreatitis | Re-challenge | Outcome |
---|---|---|---|---|---|---|
Chams et al. 2018 (our case) | 58-year-old male | Elevated amylase, lipase with CT abdomen showing pancreatitis | Amoxicillin-clavulanic acid | On day 9th of antibiotic treatment | Not performed | Clinical improvement with fluid hydration and cessation of antibiotic |
Campo et al. 2015 [7] | 42-year-old woman | Elevated lipase with CT abdomen showing pancreatitis | Amoxicillin-clavulanic acid | While on antibiotic treatment; unknown duration | Not performed | Clinical improvement with fluid hydration and cessation of antibiotic |
Cerezo Ruiz et al. 2015 [8] | 48-year-old female | Elevated lipase with US abdomen showing pancreatitis | Amoxicillin-clavulanic acid |
Data unavailable
|
Data unavailable
| Spontaneous resolution |
Sammett et al. 1998 [9] | 7-year-old male | Elevated amylase, lipase with US abdomen showing pancreatitis | Penicillin | 3 weeks prior to diagnosis was treated with 10 days of oral penicillin | Not performed | Clinical improvement with fluid hydration and food restriction |
Galindo et al.; 1995 [10] | 25-year-old male | Acute pancreatitis and cholestatic cute hepatitis | Amoxicillin-clavulanic acid | After 4 weeks of an antibiotic treatment | Not performed | Clinical improvement with fluid hydration and food restriction |
Hanlien 1987 [11] | 73-year-old woman | Elevated serum amylase, lipase and urine amylase | Ampicillin | On day 6th of antibiotic treatment | Re-exposure 2 weeks later for treatment of pneumonia, with repeat elevated enzymes on the 4th day | Clinical improvement after discontinuation of antibiotic treatment |