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[Sodium diphenylhydantoin as a probable cause of pancreatitis]
A C Sepúlveda Vildósola1, E López Aguilar, P Yáñez López
1Departamento de Gastroenterología, Hospital de Pediatría Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, México, D.F.
Introduction:
Drug-induced pancreatitis is much more common in children than in adults. Many drug have been implicated in its pathogenesis. Among the neuropsychiatric drugs only valproic acid, carbamazepine, clozapine and ergotamine have been reported. Phenytoin is commonly used for the treatment of epilepsy. It has been associated to pancreatitis only in two previous reports.
Case Report:
Male adolescent who initiated with cerebellar hemorrhage due to an arteriovenous malformation. During his evolution he presented the following complications: pneumonia, two urinary tract infection, gastrointestinal bleeding and arterial hypertension. Eighteen days after admission he developed seizures and was treated with phenytoin. The next day he presented pancreatic symptoms and pancreatitis was confirmed by elevated enzymes and a CAT scan with pancreatic edema. Other etiologies were discarded. Pancreatic enzymes persisted high until phenytoin was stopped and have been within normal values after 18 months of follow-up.
Conclusions:
In this case three of the four Miller criteria have been fulfilled. We consider that the antiepileptic treatment was the direct cause of the pancreatitis because there was a clear temporal association of the symptoms with the initiation and suspension of the drug.