A Case of Thiazide-Induced Pancreatitis

Acute pancreatitis is the inflammation of the pancreas that is most commonly caused by gallstones or alcohol in adults. Other less likely causes are autoimmune, hypercalcemia, hypertriglyceridemia, scorpion sting, trauma, idiopathic, post-endoscopic retrograde cholangiopancreatography (ERCP), or drug-induced. Our patient is a 72-year-old woman with a past medical history of hypertension (on hydrochlorothiazide 12.5 mg, amlodipine 10 mg, and losartan 100 mg), chronic hypoxic respiratory failure, and previous deep vein thrombosis (DVT) (on apixaban 2.5 mg) who presented to the emergency department with complaints of abdominal pain. She was hemodynamically stable with epigastric pain that radiated to the back and was tender on palpation. Work-up revealed a lipase of 9,130 IU/L, normal lipid profile, leukocytosis of 13,500 cells/mm³, and negative urinalysis. Imaging computed tomography (CT) of the abdomen shows acute interstitial pancreatitis with no glandular necrosis, no regional venous thrombosis, and no signs of cholelithiasis. Work-up was negative for other causes of acute pancreatitis: no recent history of trauma, no recent scorpion sting, no steroid use, low autoimmune pancreatitis antibodies, normal calcium levels, normal triglycerides, and no recent history of ERCP. CT of the abdomen as an outpatient follow-up after eight weeks revealed no underlying malignancy. On the basis of exclusion, the patient's thiazide diuretic was likely the cause of her acute pancreatitis with no other possible causes. In clinical presentations with no typical identifiable causes, it is important to have a high index of suspicion of other rare causes. In this case, an accurate medication reconciliation and a high index of suspicion allowed for the identification of this possible but less common cause.