mycophenolic-acid and Pancreatitis

Topics: Adult; Biopsy; Colitis; Colon; Colonoscopy; Diarrhea; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycophenolic Acid; Pancreatitis

Topics: Acute Disease; Adult; Anti-Inflammatory Agents; Cholangiopancreatography, Magnetic Resonance; Diagnosis, Differential; Female; Gallstones; Humans; Liver; Lupus Erythematosus, Systemic; Methylprednisolone; Mycophenolic Acid; Pancreas; Pancreatitis; Symptom Assessment; Tomography, X-Ray Computed; Treatment Outcome

Autoimmune pancreatitis is a rare form of pancreatitis characterized by responsiveness to steroid therapy and an often relapsing disease course. The mainstay of therapy is oral corticotherapy. Associations of interstitial nephritis with various autoimmune disorders have been described. We hereby report the case of a 69-year-old Caucasian man with a 2-year history of autoimmune pancreatitis, who presented with impairment of kidney function, proteinuria, and hypertension. Renal histopathology showed severe diffuse interstitial nephritis. With oral prednisone and ACE inhibitor therapy, complete recovery of kidney function was not achieved and proteinuria persisted. Therefore, mycophenolate mofetil was initiated. After 8 weeks, serum creatinine decreased, and a nearly complete and sustained resolution of proteinuria was seen, while tapering oral steroid doses. With autoreactive T cells playing a major role in the pathogenesis of both diseases, a common etiology of pancreatitis and interstitial nephritis can be assumed, and the beneficial effects of an inhibitor of lymphocyte proliferation, such as mycophenolate mofetil, can be explained. We infer from our case that mycophenolate mofetil can be effective in the control of simultaneous autoimmune pancreatitis and interstitial nephritis.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Autoimmune Diseases; Cortisone; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Nephritis, Interstitial; Pancreatitis; Prednisolone; Ramipril

Systemic corticosteroids represent the standard treatment for autoimmune pancreatitis with IgG4-associated cholangitis. For steroid-dependent disease, azathioprine has been used for maintenance of remission. Mycophenolate mofetil has been used for transplant immunosuppression and more recently for autoimmune hepatitis; however, there are no case reports to date on the use of mycophenolate mofetil in adult patients with autoimmune pancreatitis. A patient with IgG4-mediated autoimmune pancreatitis and IgG4-associated cholangitis refractory to steroids and intolerant of azathioprine was treated with mycophenolate mofetil, which inhibits de novo guanosine synthesis and blockade of both B and T lymphocyte production. Introduction of mycophenolate mofetil and uptitration to 1000 mg by mouth twice daily over a treatment period of 4 mo was associated with improvement in the patient's energy level and blood glucose control and was not associated with any adverse events. The patient was managed without a biliary stent. However, there was a return of symptoms, jaundice, increase in transaminases, and hyperbilirubinemia when the prednisone dose reached 11 mg per day. In the first report of mycophenolate mofetil use in an adult patient with IgG4-associated autoimmune pancreatitis and IgG4-associated cholangitis, the introduction of mycophenolate mofetil was safe and well-tolerated without adverse events, but it did not enable discontinuation of the steroids. Mycophenolate mofetil and other immunomodulatory therapies should continue to be studied for maintenance of remission in the large subset of patients with refractory or recurrent autoimmune pancreatitis.

Topics: Adrenal Cortex Hormones; Aged; Autoimmune Diseases; Biopsy; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Drug Therapy, Combination; Humans; Immunoglobulin G; Immunosuppressive Agents; Male; Mycophenolic Acid; Pancreatitis; Recurrence; Treatment Outcome

Pancreatitis is a relatively rare but severe manifestation in systemic lupus erythematosus (SLE) patients. We report a case of a 39-year-old woman with previous SLE diagnose treated with prednisone and mycophenolate mofetil who developed an acute pancreatitis complicated by pancreatic pseudocysts within the context of a severe lupus flare. Elevated serum amylase and computerized tomography confirmed the diagnosis and mechanical obstruction or toxic-metabolic etiologies were ruled out. In the present case, we opted for the clinical surveillance of pancreatic pseudocyst and not perform invasive medical procedures to drainage. A steroid therapy was started in order to achieve SLE and pancreatitis remission, however, it was unable to avoid the development of multiorgan failure and patient died a few days after diagnosis was made.

Topics: Acute Disease; Adult; Amylases; Biomarkers; Drug Therapy, Combination; Fatal Outcome; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Multiple Organ Failure; Mycophenolic Acid; Pancreatic Pseudocyst; Pancreatitis; Prednisone; Tomography, X-Ray Computed

Drug-induced acute pancreatitis is considered to be a rare diagnosis. The incidence of drug-induced acute pancreatitis is usually estimated from case reports.. The aim of this study was to determine the incidence, etiology, and severity of drug-induced pancreatitis during a 2-year period in a tertiary hospital.. The study was conducted as a retrospective analysis of all cases of pancreatitis in the University Hospital in Olomouc (1,432 beds) in 2006-2007. All cases of acute pancreatitis were re-evaluated and divided according to the causative factor. In drug-induced cases, the WHO Probability Scale for the evaluation of causality relationship was used.. The inclusion criteria were met by 170 medical files. There were 91 (53%) cases in men and 79 (47%) in women, and mean age was 57 years old (5-91 years old). The etiology was in 53% biliary, 31% alcohol-induced, 12% other determined, and in 4% the cause could not be established. The proportion of drug-induced acute pancreatitis was 5.3% and it was the third most frequent cause of the AP. Azathioprine was the most frequent causative factor (three cases in two patients); all the other causative drugs were documented only in single cases: mesalazine, dexamethasone, ramipril, mycophenolate mofetil, cytarabine, and valproate.. The diagnosis of drug-induced acute pancreatitis seems to be underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected causative factors. The disease is more probable in younger persons, women, and patients suffering from Crohn's disease.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Azathioprine; Child; Child, Preschool; Crohn Disease; Cytarabine; Dexamethasone; Female; Humans; Immunosuppressive Agents; Incidence; Male; Mesalamine; Middle Aged; Mycophenolic Acid; Pancreatitis; Ramipril; Retrospective Studies; Risk Factors; Severity of Illness Index; Valproic Acid; Young Adult

The aim of this study was to determine the effects of mycophenolate mofetil (MMF) on acute pancreatitis with evaluation of biochemical and histopathological findings.. Cerulein was administered to induce acute pancreatitis in rats. Three groups of 10 rats each were formed. Animals in group 1 received physiologic saline solution. In group 2 animals received MMF at a dose of 14 mg/kg and group 3 had double doses of MMF. Alanine aminostransferase, aspartate aminotransferase (AST), amylase and bilirubin levels were assessed. Pancreatic tissues were evaluated under light microscopy for the presence of edema, acinar necrosis, hemorrhage, inflammation and perivascular infiltration.. Amylase, serum AST, edema and inflammatory infiltration levels differed between groups (amylase: p = 0.0001, serum AST: p = 0.001, edema: p = 0.0001 and inflammatory infiltration: p = 0.002), group 1 showing the highest amylase, serum AST and edema levels. The lowest levels of edema were found in group 3.. In an experimental pancreatitis model in rats, MMF proved to exert a beneficial effect on biochemical and histopathological parameters.

Topics: Alanine Transaminase; Amylases; Animals; Anti-Inflammatory Agents, Non-Steroidal; Aspartate Aminotransferases; Bilirubin; Ceruletide; Female; Immunosuppressive Agents; Male; Mycophenolic Acid; Pancreatitis; Rats; Rats, Wistar

Topics: Anti-Inflammatory Agents, Non-Steroidal; Duodenitis; Humans; Male; Middle Aged; Mycophenolic Acid; Pancreatitis; Sarcoidosis

Pancreatitis following kidney transplantation was first described by Starzl in 1964 [19]. The incidence rate of the disease involving severe complications ranges from 1.2 to 6.8%. The number of risk factors, besides those of the normal population, is increased by a number of other factors, i.e. uremia, disorder of lipid metabolism, polycystic kidney, immunosuppressive drugs, cytomegalovirus infection, etc. The mortality of acute pancreatitis in a kidney transplant patient is, in spite of treatment with the most up-to-date methods, is much higher (53-60%) than that for a non-transplant patient. In the period between 27 June 1991 and 31 December 2000 the number of cadaver kidney transplants performed in the Transplantation Division of the 1st Department of Surgery of the Medical and Health-Science Centre of the University of Debrecen was 349. During this period 9 incidences of acute pancreatitis were found in 8 patients. The frequency of incidence was 2.56%. In the present communication we analyse the prognosis of 9 kidney transplant patients, with special respect to immunosuppression.. One patient was administered Cyclosporin alone, four were given Cyclosporin and Steroids, a further one Cyclosporin, Steroids and Azathioprine, the remaining three were treated with Cyclosporin, steroids and Mycophenolate Mophetil. In six cases out of nine multiorgan insufficiency (kidney, lung, liver) was encountered on presentation, three cases were accompanied by peritonitis. In spite of early jejunal nutrition, intensive therapy, antibiotic treatment, CT monitoring, if needed, necrectomy and oncotomy, three of our patients died from multiorgan insufficiency induced by septico-toxic state (mortality 33.3%). Other six patients recovered.. The mortality rate of acute pancreatitis is much higher in immunosuppressed patients. The role of the etiological factors is not unequivocal in the development of pancreatitis. Nevertheless, all possible risk factors have to be taken into consideration when starting the immunosuppressive treatment of transplant patients and during their follow-up. By optimally adjusting the immunosuppressants we can decrease the risk of pancreatitis, however, the prognosis of the diseases, in agreement with the data in the literature, cannot be considerably improved even with the most up-to-date methods.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Azathioprine; Cadaver; Cyclosporine; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Multiple Organ Failure; Mycophenolic Acid; Pancreatitis; Peritonitis; Retrospective Studies; Risk Factors