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Nitrofurantoin induced acute pancreatitis
Selim Mosbahi, Matthias K. Peter and Bernhard Egger
Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg
BACKGROUND
RESULTS
Drug induced acute pancreatitis is rare with an
incidence of 3-5% and the identification of the causal
drugs may remain challenging1.
Nowadays, nitrofurantoin (Uvamin®, Furadantin®,
Macrobid®, Macrodantin®, Nitro Macro®) is a very often
prescribed treatment for uncomplicated lower urinary
tract infection with to date 3 reported cases of druginduced acute pancreatitis2-4 .
We hereby present two cases of nitrofurantoin induced
pancreatitis.
Both patients were kept fasting for 2 days until relief of
symptoms. After re-review of their past medication, they
both admitted taking nitrofurantoin until 4 days before
admission (case 1) and for the last 4 days (case 2). No
other medication, laboratory investigation or radiological
finding could explain the pancreatitis. The clinical and
biochemical picture cleared rapidly after discontinuation
of the drug. The follow-up’s were uneventful and the
patients discharged home after 65 hours (case 1) and
49 hours (case 2), respectively.
CASES REPORTS
Case 1: A 27 years old woman without any surgical or
medical history presented at our emergency
department complaining of progressive left upper
quadrant abdominal pain for the last 10 days.
Case 2: A 76 years old woman with a history of biliary
pancreatitis and a cholecystectomy presented at our
emergency department complaining of progressive
epigastric pain for the last 2 days.
In both cases personal history was completely normal
(especially no alcohol consumption) and lab tests
revealed a CRP (7 and 118 mg/L), mild leukocytosis
(11.4 and 10.6 G/L), elevated lipase (1139 and 4647
U/L). Calcium, triglyceride, hepatic and cholestatic
values were normal and a CT-scan confirmed a
Balthazar C pancreatitis in both patients. Gallstones
and sludge in the gallbladder (case 1) or the biliary tree
(case 1 & 2) could be excluded by an abdominal
ultrasound.
Case 1. Abdominal CT-Scan showing an edematous pancreas
CONCLUSION
This double case report shows the importance of a
concise medication history. The increasing number of
cases reported in the literature (1-4) and the present
abstract should contribute to raise the suspicion of an
association
between
nitrofurantoin
(Uvamin®,
Furadantin®, Macrobid®, Macrodantin®, Nitro Macro®)
and drug induced pancreatitis.
REFERENCES
1.
2.
3.
4.
Ina K et al. J. Gastroenterol 2003;38:111
Peterson M et al. West J Med 1994;61:148
Fang SB et al. Eur J Pediatr 2000;159:714
Jassim et al. Grand Rounds 2011;11:17
Nitrofurantoin drug molecule
Case 2. Abdominal CT-Scan showing an edematous pancreas and a status post-cholecystectomy