TWO EPISODES OF ACUTE PANCREATITIS TRIGGERED BY CONSECUTIVE ADMINISTRATION OF 5-AMINOSALICYLIC ACID AND AZATHIOPRINE THERAPY FOR CROHN'S DISEASE

Acute pancreatitis is a rare but potentially fatal adverse effect of both 5-Aminosalicylic Acid and Azathioprine. Drug-induced pancreatitis is often diagnosed only after ruling out the more common causes of pancreatitis such as gallstones, coupled with symptomatic relief and normalisation of blood tests on stopping the causative drug. We describe a case involving a 31 year old lady with a history of Crohn’s disease presenting with acute abdominal pain, raised WCC and markedly elevated amylase levels 4 weeks after commencing Pentasa (5-ASA) for Crohn’s disease. Two years later, after being commenced on Azathioprine, the patient was again readmitted with identical symptoms with raised amylase and WCC. This case report highlights the importance of considering drug induced pancreatitis in patients on 5-ASA and Azathioprine. 1. CASE REPORT AP is a 31 year old lady who is normally fit and well with a family history of Crohn’s disease. She presented with a 3 month history of lower abdominal cramping pain associated with loose stools up to four times daily, no rectal bleeding and some weight loss. She complained of no other extra-intestinal symptoms. Her blood tests revealed elevated CRP, ESR and platelet count. She subsequently underwent a flexible sigmoidoscopy which showed an erythematous mucosa, patchy neovascularisation and mild ulceration in the distal sigmoid colon, however, histological analysis of the biopsies taken from the sigmoid colon and rectum were of normal mucosa. A barium meal and follow through was normal. Clinically the suspicion of Crohn’s disease was high but at the time of the consultation the patient was asymptomatic hence was managed conservatively. Ten months later AP presented with an acute flare up of Crohn’s disease, which was based on a white cell study. She was commenced on a reducing course of Prednisolone and Pentasa (5-ASA), but 4 weeks later presented to the Emergency department complaining of severe sharp abdominal pain that radiated to her back with nausea but no vomiting. On examination she was found to be tachycardic but otherwise stable. Her abdomen was soft, tender in the right upper quadrant but no guarding and normal bowel sounds. The rest of the examination was unremarkable. Initial clinical investigations revealed an elevated WCC (20.97x10 9