S3646 Dapagliflozin-Induced Necrotizing Pancreatitis: A Case Report

Introduction: Necrotizing pancreatitis, a severe form of acute pancreatitis, involves pancreatic tissue death and may lead to systemic complications requiring intensive care. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors, such as dapagliflozin, are used to manage type 2 diabetes, chronic kidney disease, and heart failure. While generally safe, rare instances of acute pancreatitis have been reported with SGLT-2 inhibitor use. This report discusses a case of necrotizing pancreatitis potentially induced by dapagliflozin. Case Description/Methods: A 72-year-old woman with insulin-dependent type 2 diabetes, coronary artery disease, stage 2 chronic kidney disease, and nonalcoholic steatohepatitis presented with hematemesis. Her medications included dapagliflozin, initiated approximately 2 weeks prior. She denied alcohol use, recent trauma, or gallstones. Laboratory tests revealed a lipase level of 16,600 U/L, an anion gap of 23, and a white blood cell count of 24,000/μL. Imaging confirmed acute interstitial edematous pancreatitis without biliary obstruction. Despite initial improvement with antibiotics, she was readmitted a week later with worsening symptoms. Imaging showed bilateral pleural effusions and necrotizing pancreatitis. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement and necrosectomy. Cultures grew multidrug-resistant Enterococcus faecium. After further interventions, including additional necrosectomies and antibiotic therapy, her condition stabilized, and she was discharged to a skilled nursing facility. Discussion: This case highlights a rare instance of necrotizing pancreatitis potentially associated with dapagliflozin use. The exact mechanism by which SGLT-2 inhibitors might induce pancreatitis is unclear. Proposed theories include drug-induced dehydration leading to lactic acidosis, alterations in insulin and glucagon levels promoting ketosis, and idiosyncratic immune or cytotoxic reactions. While large-scale studies have not established a definitive link between SGLT-2 inhibitors and pancreatitis, isolated case reports suggest a possible association. Clinicians should remain vigilant for signs of pancreatitis in patients initiating SGLT-2 inhibitors and consider discontinuation if symptoms arise. Further research is needed to elucidate the relationship between SGLT-2 inhibitors and pancreatic inflammation.