Azatioprin iliﬂkili akut pankreatit: Bir olgu sunumu

Akut pankreatit önemli bir hastalıktır ve bir çok ilaç akut pankreatit nedeni olarak suçlanmıştır. Bu bildiride azatioprin ve budesonid kombinasyonu alan bir Crohn hastasında gelişen akut pankreatit sunulmaktadır. Otuz yaşında,bayan,aktif Crohn hastası mesalazine yanıtsız olup bundan 10 gün önce hastaya bu kombinasyon tedavisi başlanmıştı. Akut pankreatit kendisini klinik bulgular ve yüksek amilaz düzeyi ile belli etti. Bilgisayarlı tomografi akut ödematöz pankreatiti doğruladı. Klinik ve biyokimyasal anormallikler kombinasyon tedavisi kesilmesinden sonra yatıştı ve yüksek Crohn hastalığı aktivitesi nedeniyle en kısa sürede budesonid yeniden başlandı. Üç aylık takip periyodunda yeni atak gelişmedi. Sonuç olarak, bu yan etki Crohn hastalığı tedavisi sıra- sında akılda tutulmalıdır. laç ilişkili akut pankreatit benign seyirli olma- sına rağmen, azatioprin kullanım programı ve olası yan etkilerin takibi konusu düşünülmelidir.

Azathioprine related acute pancreatitis: A case report

Acute pancreatitis is an important disease. Several drugs have been re- ported among causes of acute pancreatitis. In this report, we present a case of Crohn disease who developed acute pancreatitis under tre- atment of azathioprine and budesonide combination. A 30-year-old woman with active Crohn disease was unresponsive to mesalazine and was given azathioprine and budesonide 10 days ago. Diagnosis of acute pancreatitis was established with clinical symptoms, elevated se- rum amylase level and computed tomography findings of acute ede- matous pancreatitis.Clinical and biochemical abnormalities resolved after discontinuation of this combination therapy. We restarted bude- sonide as soon as possible because of the high Crohn disease activity. No new attack occurred after a period of three months. This adverse effect should be kept in mind during the treatment of Crohn disease. Despite drug induced acute pancreatitis usually runs a benign course, one must follow the standardized azathioprine use instructions strict- ly and consider the possible side effects.

PDF

___

1.Herrlinger KR, Stange EF. The pancreas and inflammatory bowel diseases. Int J Pancreatol 2000; 27:171-9.

2.Floyd A, Pedersen L, Nielsen GL, et al. Risk of acute pancreatitis in users of azathioprine: a population-based case-control study. Am J Gastroenterol 2003;98:1305-8.

3.Sandborn W, Sutherland L, Pearson D, et al. Azathioprine or 6- mercaptopurine for inducing remission of Crohn's disease. Cochra- ne Database Syst Rev 2000:CD000545.

4.Nogueira JR, Freedman MA. Acute pancreatitis as a complication of Imuran therapy in regional enteritis. Gastroenterology 1972;62:1040-1.

5.Andersen V, Sonne J, Andersen M. Spontaneous reports on drug- induced pancreatitis in Denmark from 1968 to 1999. Eur J Clin Pharmacol 2001;57:517-21.

6.Vinklerová I, Procházka M, Procházka V, Urbánek K. Incidence, se- verity, and etiology of drug-induced acute pancreatitis. Dig Dis Sci 2010;55:2977-81.

7.Eland IA, van Puijenbroek EP, Sturkenboom MJ, et al. Drug-asso- ciated acute pancreatitis: twenty-one years of spontaneous repor- ting in The Netherlands. Am J Gastroenterol 1999;94:2417-22.

8.Lankisch PG, Dröge M, Gottesleben F. Drug induced acute pancre- atitis: incidence and severity. Gut 1995;37:565-7.

9.Barreto SG, Tiong L, Williams R. Drug-induced acute pancreatitis in a cohort of 328 patients. A single-centre experience from Australi- a. JOP 2011;12:581-5.

10.Kahan BD. Efficacy of sirolimus compared with azathioprine for re- duction of acute renal allograft rejection: a randomized multicen- tre study. The Rapamune US Study Group. Lancet 2000;356:194- 202.

11.Haber CJ, Meltzer SJ, Present DH, Korelitz BI. Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment if inf- lammatory bowel disease. Gastroenterology 1986;91:982-6.

12.Venkatesh PG, Navaneethan U. Azathioprine induced pancreatitis in a patient with co-existing autoimmune pancreatitis and hepati- tis. JOP 2011;12:250-4.

13.Mallory A, Kern F Jr. Drug induced pancreatitis: A critical review. Gastroenterology 1980;78:813-20.

14.Sturdevant RA, Singleton JW, Deren JL, et al. Azathioprine-related pancreatitis in patients with Crohn's disease. Gastroenterology 1979;77:883-6.