Tigecycline-Induced Acute Pancreatitis with Rechallenge: A Case Report

Objective: To report a case of tigecycline-induced acute pancreatitis. Case Summary: A 50-year-old African American man with spinal cord injury was hospitalized on 2 occasions for recurrence of an infected pressure ulcer requiring systemic antibiotic therapy. Bone and tissue cultures from his initial hospitalization grew multidrug resistant (MDR) Acinetobacter baumanii sensitive to tigecycline. He was treated with intravenous tigecycline on these 2 occasions (50-mg infusions every 12 hours), each of which resulted in significant elevation in serum amylase (to 615 U/L and 715 U/L) and lipase (to 325 U/L and 616 U/L) levels. On each occasion, the pancreatic enzymes became normal after discontinuing tigecycline. Discussion: Tigecycline is the first FDA-approved drug in the class of antibiotics called glycylcyclines, which are developed from tetracyclines to afford broad coverage against certain resistant gram-positive and gramnegative bacteria. It is recommended for patients at least 18 years of age for treatment of complicated intraabdominal infections, community-acquired bacterial pneumonia and complicated skin and skin structure infections caused by susceptible organisms. Tigecycline-induced pancreatitis is a rare adverse event. Review of the literature yielded only 6 prior documented cases (5 adult and 1 pediatric cases). Although the pediatric case demonstrated rechallenge, the patient concurrently received other antibiotics that are known to cause pancreatitis. Conclusions: This is the first report, to our knowledge, of pancreatitis associated with monotherapy with tigecycline, and this relationship was confirmed upon rechallenging our patient with tigecycline. An objective causality assessment revealed that the adverse-drug-associated event was definite.