Case Presentation: A 20-year-old male with past history of asthma presented initially with bloody diarrhea and subjective fever of one day’s duration. Upon evaluation vital signs revealed temperature of 103 F, and tachycardia. On physical examination there was generalized abdominal tenderness with normal bowel sounds. Thrombocytopenia was present with platelet count of 46 k/ul. Antibiotics were begun for treatment of possible colitis but the platelet count trended down to 6 k/ul. He was diagnosed with immune thrombocytopenia (ITP) secondary to viral infection vs. toxic colitis. Intravenous immunoglobulin and dexamethasone were administered. Platelet count began to rise and the patient clinically improved. He was discharged on oral prednisone. Three days later the patient returned with epigastric pain and a lipase level of 1132 U/L. CT abdomen confirmed the diagnosis of acute pancreatitis without cholelithiasis. Serum calcium and triglyceride levels both were normal and the patient denied alcohol use. Steroid induced pancreatitis was considered based on history, imaging study results, and biochemical markers.
Discussion: Drugs are a relatively rare cause of acute pancreatitis, with incidence rates between 0.1-2%. [1], Many drugs have been reported as the cause of acute pancreatitis. Severity may vary from case to case, but usually is mild to moderate in severity and not associated with complications [2]. Steroid induced acute pancreatitis has been reported. The relationship between using high dose steroid and acute pancreatitis has been previously reported. The diagnosis of such cases requires high suspicion, exclusion of other causes and a clear history of recent steroid use. Acute pancreatitis is a common diagnosis secondary to cholelithiasis, alcohol, infections, trauma and other causes; however steroid induced pancreatitis is a challenging diagnosis which may require extensive workup to rule out other possibilities. Increasing doses of steroids may increase the risk of acute pancreatitis based on previous studies [3]. Generally, acute pancreatitis develops within 14 days of the initial exposure to the agent. The mechanism by which oral glucocorticoid treatment might induce acute pancreatitis is unknown and needs to be investigated in future experimental studies [4] Our case provides further evidence of the relationship between use of steroids and acute pancreatitis,
Conclusions: Steroid induced acute pancreatitis has been reported. However, the diagnosis of steroid induced pancreatitis is challenging, requiring careful review of the medical history and exclusion of other possible etiologies [5].