Abstract
Introduction Drug-induced pancreatitis is a diagnosis made when symptoms resolve with drug cessation and recur in accordance with a re-challenge of the same drug. We report a case of fenofibrate-induced recurrent pancreatitis. Case Presentation A 79-year-old male with a medical history of cholelithiasis, for which he underwent cholecystectomy 11 years ago was admitted for acute pancreatitis. His presentation included severe epigastric pain, lipase of 1840 u/L, and no organ failure. The patient denied alcohol consumption and have quit smoking 41 years ago. Laboratory markers are seen in "Table 1". Abdomen CT scan demonstrated peripancreatic haziness consistent with acute pancreatitis "Figure 1". The patient recovered well. Home medications included atorvastatin for several years, and the addition of 160 mg fenofibrate six months prior to admission. These medications were held upon admission but resumed at discharge. Three days later, the patient returned with similar symptoms. Lipase levels were >30,000 u/l and imaging were consistent with acute pancreatitis. The patient improved clinically, fenofibrate and atorvastatin were discontinued at discharge. Two months later, the patient underwent EUS with pancreatic head FNA and ERCP. Cytology was negative for melignancy. Cholangiogram revealed a normal biliary system. No recurrence of pancreatitis has occurred at 9-month follow-up. Discussion Drug-induced pancreatitis accounts for 0.1% - 2% of acute pancreatitis. Treatment with fibrates has been associated with the development of acute pancreatitis.Clofibrate was associated with a 50% increased risk of developing cholelithiasis or cholecystitis, thus increasing the risk of acute pancreatitis.Fenofibrate is less likely to induce gallstone formation. The only case involving fenofibrate-associated pancreatitis was in patient on simvastatin, a class 1A medication, and fenofibrate who developed acute pancreatitis. There was no re-challenge done as the patient expired during a complicated hospital course. Given that all other known causes of acute pancreatitis were ruled out, along with a positive re-challenge to the medication, we theorize that fenofibrate should be regarded as a class 1A medication in the classification of drug-induced pancreatitis. Furthermore, we believe that fenofibrate may cause pancreatitis by a different mechanism than previously theorized in literature, as there was no evidence of biliary stones or sludge in this case.