Corticosteroid-Induced Pancreatitis in Patients with Autoimmune Bullous Disease: Case Report and Prospective Study

Abstract

Corticosteroid pulse therapy using very high doses may produce corticosteroid-induced pancreatitis (CIP) that is unexpected during conventional oral corticosteroid therapy and may sometimes be fatal. Our goal was to evaluate the relation between pulse corticosteroid administration and pancreatitis. A case of CIP is reported, and a prospective study was performed. Corticosteroid pulse therapy followed by 30 mg prednisolone orally was utilized in 7 hospitalized patients with autoimmune bullous disease, and serum pancreatic enzymes were measured during therapy. The case report revealed reproducible pancreatitis in a dose-dependent manner after 2 corticosteroid regimens. In the prospective study, serum pancreatic enzyme levels increased significantly within several days after pulse therapy, then decreased with tapering of the dose of oral prednisolone. Laboratory pancreatic alterations appear to be induced within days after pulse corticosteroid administration in a dose-dependent manner: less than 25 mg of oral prednisolone may be below threshold to alter the pancreatic enzyme level.

Acute necrotising pancreatitis derived from low-dose corticosteroid use: an important reminder of clinical management

“…Although the pathophysiological mechanism behind corticosteroid-induced pancreatitis remains unclear, recent data suggest it may be related to the systemic effects of these medications, and specific alterations of lipid and calcium metabolism in pancreatic cells 4. The current literature on epidemiological incidence of oral corticosteroid use suggests that the risk of acute pancreatitis was increased among current users compared with non-users, and the risk for development of this condition was highest 4–14 days after the medication was taken 3.…”

Association of Oral Glucocorticoid Use With an Increased Risk of Acute Pancreatitis

“…Several case studies have reported development of acute pancreatitis linked with oral glucocorticoid use. [11][12][13][14][15][16] In 2 case reports, acute pancreatitis recurred following readministration of dexamethasone 14 and prednisone. 16 However, more epidemiological studies are warranted before the association can be established.…”

“…10 In addition, several case reports have described induction of acute pancreatitis in patients treated with glucocorticoids. [11][12][13][14][15][16] In 2 of these case reports, there was a positive rechallenge with oral dexamethasone 14 and prednisone. 16 Importantly, some indications of glucocorticoid therapy, eg, inflammatory bowel disease, 17 systemic lupus erythromatosus, 18 and Wegener granulomatosis, 19 could be risk factors for acute pancreatitis resulting in confounding by indication.…”

Glucocorticoids in the treatment of bullous diseases

“…Therefore it is difficult to conclude that the pancreatitis results from GC toxicity and not from other drugs or combinations of drugs. A study by Yoshizawa et al (69) demonstrated that patients with autoimmune blistering diseases showed an elevation in serum pancreatic enzymes within several days after the pulse dosing in a dose‐dependent manner. Therefore careful monitoring of pancreatic function in this patient population is recommended (69).…”