Probable Vildagliptin-Associated Acute Pancreatitis in a Patient With Well-Controlled Type 2 Diabetes Mellitus: A Case Report

Drug-induced acute pancreatitis (DIAP) is rare, accounting for approximately 0.1%-5% of all cases, and the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and pancreatitis remains controversial despite postmarketing safety signals. We report the case of a 46-year-old man with well-controlled type 2 diabetes mellitus who presented with severe epigastric pain radiating to the back after six months of therapy with vildagliptin and metformin. Laboratory evaluation showed markedly elevated serum amylase (1,220 U/L) and lipase (2,334 U/L), exceeding three times the upper limit of normal, while contrast-enhanced CT demonstrated acute interstitial edematous pancreatitis without evidence of necrosis. A systematic evaluation excluded common etiologies, including gallstones, alcohol use, hypertriglyceridemia, hypercalcemia, pancreaticobiliary obstruction, and structural abnormalities. Vildagliptin was promptly discontinued, and the patient received supportive management, with complete clinical recovery. The temporal association, exclusion of alternative causes, and improvement following drug withdrawal (positive dechallenge), together with a Naranjo Adverse Drug Reaction Probability Scale score of 7, support a probable drug-related association, with vildagliptin considered the most likely causative agent. Clinicians should remain aware of this rare but potential adverse effect when evaluating patients receiving DPP-4 inhibitors who present with acute pancreatitis after exclusion of more common causes.