P1496 - The Pancreas Puzzle: Unveiling the Mystery of Irbesartan-Induced Pancreatitis

Carolina Villarroel, MD¹, Rohit Nathani, MD², Michael Smith, MD^2
1Mount Sinai Beth Israel Hospital, New York, NY; ²Mount Sinai Morningside and West Hospital, New York, NY

Introduction: Acute pancreatitis arises from a systemic inflammatory response, and its severe forms are associated with significant morbidity and mortality. The main causes of this condition are alcohol consumption and gallstones, with additional factors including infections, metabolic and autoimmune disorders, iatrogenic injuries, and rarely, certain medications. Drug-induced pancreatitis (DIP) is a relatively uncommon occurrence, with an estimated incidence of 0.1-2%. Here, we present a case of acute pancreatitis associated with Irbesartan.

Case Description/Methods: A 73-year-old female with a medical history significant for hypertension (HTN), hyperlipidemia (HLD), hypothyroidism, nephrolithiasis, and coronary artery disease (CAD) status post percutaneous coronary intervention (PCI) with drug-eluting stent (DES) presented to the emergency department (ED) with severe epigastric pain radiating to the back. Physical examination revealed a soft and non-distended abdomen with tenderness upon palpation in the right upper quadrant, without rebound or guarding. Laboratory studies showed elevated white blood cell count (15.5 K/uL), aspartate aminotransferase (AST) of 106 U/L, alanine aminotransferase (ALT) of 100 U/L, and markedly elevated lipase levels (4,500 U/L). Total bilirubin and coagulation studies were within normal limits. Ultrasonography of the right upper quadrant revealed gallbladder wall thickening and minimal pericholecystic fluid. Magnetic resonance cholangiopancreatography (MRCP) revealed acute interstitial pancreatitis without evidence of cholelithiasis or choledocholithiasis. The patient had no history of alcohol use disorder, and an extensive investigation ruled out other common causes. Irbesartan initiated just two days prior to the onset of symptoms, was identified as a potential causative agent.


Discussion: Irbesartan is a frequently prescribed medication for blood pressure. Although rare, drug-induced acute pancreatitis has been associated with this medication, and its diagnosis primarily relies on excluding common causes of pancreatitis. Our case demonstrated the importance of maintaining a high level of suspicion for drug-induced pancreatitis in patients after the common causes of acute pancreatitis have been ruled out.


Disclosures:


Carolina Villarroel, MD¹, Rohit Nathani, MD², Michael Smith, MD². P1496 - The Pancreas Puzzle: Unveiling the Mystery of Irbesartan-Induced Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.