Sodium diphenylhydantoin as a probable cause of pancreatitis
Sepúlveda Vildósola, A.C.; López Aguilar, E.; Yáñez López, P.; Ramírez Colorado, R.; Escobar Padilla, B.; Madrazo De la Garza, A.
Revista de Gastroenterologia de Mexico 64(4): 186-189
1999
ISSN/ISBN: 0375-0906 PMID: 10851582 Document Number: 7647
Drug-induced pancreatitis is much more common in children than in adults. Many drug have been implicated in its pathogenesis. Among the neuropsychiatric drugs only valproic acid, carbamazepine, clozapine and ergotamine have been reported. Phenytoin is commonly used for the treatment of epilepsy. It has been associated to pancreatitis only in two previous reports. Male adolescent who initiated with cerebellar hemorrhage due to an arteriovenous malformation. During his evolution he presented the following complications: pneumonia, two urinary tract infection, gastrointestinal bleeding and arterial hypertension. Eighteen days after admission he developed seizures and was treated with phenytoin. The next day he presented pancreatic symptoms and pancreatitis was confirmed by elevated enzymes and a CAT scan with pancreatic edema. Other etiologies were discarded. Pancreatic enzymes persisted high until phenytoin was stopped and have been within normal values after 18 months of follow-up. In this case three of the four Miller criteria have been fulfilled. We consider that the antiepileptic treatment was the direct cause of the pancreatitis because there was a clear temporal association of the symptoms with the initiation and suspension of the drug.
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