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Tigecycline-Induced Acute Pancreatitis with Electrocardiogram Changes in Renal Insufficiency Elderly
Hong Chin Wee1,2, Ru Shing Ng1,2, Loke Meng Ong1,3
1Clinical Research Centre, Hospital Pulau Pinang, Georgetown, Malaysia; Ministry of Health, Putrajaya, Malaysia.
Background:
The prevalence of multidrug-resistant and extensively drug-resistant pathogens has led to increased reliance on broad-spectrum antimicrobials, such as tigecycline. This medicine is commonly used to treat complicated skin and intraabdominal infections as well as community-acquired pneumonia. However, the increasing use of tigecycline has been linked to serious complications, including acute pancreatitis.
Case Description:
We present a case of tigecycline-induced acute pancreatitis in a 78-year-old man with complex medical conditions, including type 2 diabetes mellitus, chronic renal insufficiency, and triple vessel disease. The patient was initially treated with tigecycline for bilateral dry gangrene of his toes. Six days after initiation of the tigecycline treatment, the patient developed symptoms of acute pancreatitis with electrocardiogram changes. Magnetic resonance imaging confirmed the diagnosis of acute pancreatitis. Tigecycline was stopped promptly, and supportive treatment was initiated. The patient recovered from the acute pancreatitis and was discharged home. He later passed away at home due to his underlying cardiac disease.
Conclusions:
This case highlights the potential complications of tigecycline therapy, particularly in patients with significant comorbidities.
Learning Points:
Elderly patients with complex medical issues, such as diabetes mellitus type 2, chronic renal insufficiency, and cardiovascular disease, are at higher risk for adverse drug reactions. Recognizing these risk factors is important for management.Addressing the use of magnetic resonance imaging for diagnosing acute pancreatitis in this specific patient due to their already compromised kidneys highlights the need for a tailored approach. Most commonly, angiographic transformers or computed tomography scan are used for high-risk patients.The symptoms of acute pancreatitis and the presence of cardiac diseases cause problems in managing patients. Changes on the electrocardiogram may suggest cardiac overload; as a result, constant follow-up is necessary for patients suffering from underlying cardiac conditions.
Insights
Tigecycline, a broad-spectrum antibiotic, can cause acute pancreatitis, a serious complication. Elderly patients with multiple health issues are particularly at risk for this adverse drug reaction.
Area of Science:
- Pharmacology
- Internal Medicine
- Gastroenterology
Background:
- Rising antimicrobial resistance necessitates broad-spectrum antibiotics like tigecycline.
- Tigecycline is used for complex skin, intra-abdominal infections, and pneumonia.
- Tigecycline use is associated with serious complications, including acute pancreatitis.
Purpose of the Study:
- To report a case of acute pancreatitis induced by tigecycline.
- To highlight the risks of tigecycline in elderly patients with comorbidities.
Main Methods:
- A case study of a 78-year-old male patient with type 2 diabetes, renal insufficiency, and cardiovascular disease.
- Diagnosis of acute pancreatitis confirmed via Magnetic Resonance Imaging (MRI).
Main Results:
- The patient developed acute pancreatitis six days after starting tigecycline.
- Discontinuation of tigecycline and supportive care led to recovery from pancreatitis.
- The patient's underlying cardiac condition ultimately led to his death.
Conclusions:
- Tigecycline can induce acute pancreatitis, especially in elderly patients with multiple comorbidities.
- Risk factors for adverse drug reactions must be recognized for effective patient management.
- Diagnostic imaging choices (e.g., MRI vs. CT) require tailoring to patient's renal status.
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