Acute Pancreatitis Associated With Anaphylactic Shock: A Case Report and Literature Review

Acute pancreatitis is most commonly caused by gallstones or alcohol abuse, although rare etiologies such as drug-induced anaphylaxis have been described. Pancreatic involvement during anaphylactic shock remains exceptional and is likely underdiagnosed. We report the case of a 58-year-old woman who developed acute circulatory shock shortly after the topical application of a hemorrhoidal ointment (TriAnal). She presented with hypotension, tachycardia, pruritus, and erythematous urticarial lesions. Laboratory investigations revealed elevated serum lipase and tryptase. Abdominal computed tomography demonstrated peripancreatic fat stranding and focal pancreatic enlargement, consistent with mild edematous pancreatitis (Balthazar grade C). The patient was treated promptly with epinephrine, corticosteroids, fluid resuscitation, and vasopressor support, leading to rapid clinical and biochemical improvement. Pancreatic injury in the context of anaphylactic shock may result from a dual mechanism involving ischemia due to hypoperfusion and immune-mediated inflammation triggered by the release of vasoactive mediators. This form of pancreatitis is often clinically silent, with abdominal pain that may be absent or transient, making biological and radiological findings essential for diagnosis. Early hemodynamic stabilization remains the cornerstone of management, and pancreatic abnormalities generally resolve quickly. Although rare, acute pancreatitis associated with anaphylactic shock is probably underrecognized, and clinicians should consider this diagnosis in cases of severe anaphylaxis, particularly in the presence of digestive symptoms or unexplained elevations of pancreatic enzymes, as prompt recognition and appropriate management are key to ensuring favorable outcomes.