A Case Report of Metronidazole-Induced Pancreatitis

Abstract

Case Summary: A 23-year-old African-American female came to the emergency department with sudden onset epigastric pain associated with nausea having begun one day before presentation. Her symptoms started after the third dose of Metronidazole therapy for treatment of bacterial vaginosis. Clinical examination showed moderate epigastric tenderness. Lipase was 771 IU/L on admission. CT abdomen showed mild haziness of peripancreatic fat, which was suggestive of inflammation and diagnosis of acute pancreatitis was made. A detailed history and biochemical evaluation excluded pancreatitis-gallstones, recent increased alcohol intake, ERCP, hypercholesterolemia, hypercalcemia or viral infections. Symptoms resolved quickly upon discontinuation of metronidazole. We conclude therefore that Metronidazole was thought the most probable etiological factor. Discussion: The proportion of cases of Metronidazole-induced pancreatitis occurs in less than 1% in the general population, and the mechanism of action is not well known. Overall has a benign clinical course when assessed and treated appropriately. Conclusion: There are only 15 previous case reports of Metronidazole-induced pancreatitis in the literature to our best knowledge. Identification of Metronidazole as the causative agent is the key to recovery, and physicians should discontinue metronidazole in patients with pancreatitis of no identifiable source to ensure proper healing.