S3289 Augmentin-Induced Pancreatitis: A Case Report

Introduction: Acute pancreatitis is a common gastrointestinal emergency with well-known etiologies such as gallstones, alcohol, and hypertriglyceridemia. However, in 10–30% of cases, no obvious cause is identified, prompting evaluation for rare causes, including drug-induced pancreatitis (DIP). Although DIP accounts for <2% of cases, it remains an important differential, especially with the increasing use of broad-spectrum antibiotics. Here, we report a rare case of acute pancreatitis associated with Augmentin (amoxicillin-clavulanate). Case Description/Methods: A 24-year-old man with no significant past medical history presented with acute epigastric pain radiating to the back, accompanied by nausea and vomiting. He denied alcohol or illicit drug use and had no recent trauma or dietary changes. He was afebrile and hemodynamically stable. Labs showed leukocytosis, lipase of 1000 U/L, and amylase of 500 U/L. Computed tomography abdomen revealed peripancreatic fat stranding. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) ruled out gallstones and biliary obstruction. Workup for hypertriglyceridemia, hypercalcemia, and autoimmune pancreatitis (IgG4) was negative. On further history, the patient had taken Augmentin for sinusitis 5 days prior to symptom onset. No other new medications were identified. Given the absence of other identifiable causes and the temporal relationship, a diagnosis of Augmentin-induced pancreatitis was made. He improved with supportive care and discontinuation of the antibiotic. Discussion: Drug-induced pancreatitis is a diagnosis of exclusion. Several medications are known culprits, but Augmentin is rarely reported. Only 4 prior cases are described in the literature. Proposed mechanisms include direct acinar cell toxicity or immune-mediated injury. The diagnosis of acute pancreatitis requires 2 of 3 criteria: typical abdominal pain, enzyme elevation >3× ULN, and characteristic imaging. This case met all 3. Clinicians should maintain a high index of suspicion for drug-induced causes of acute pancreatitis in patients without common risk factors. While rare, Augmentin should be recognized as a potential trigger. Early identification and cessation of the offending agent are key to recovery and prevention of recurrence.