Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 291-295
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.291
Acetaminophen-induced acute pancreatitis: A case report and literature review
Ya-Hong He, Lei Lu, Yu-Fang Wang, Jin-Song Huang, Wei-Qin Zhu, Yan Guo, Chun-Xia Li, Hua-Ming Li
Ya-Hong He, Yu-Fang Wang, Jin-Song Huang, Wei-Qin Zhu, Yan Guo, Chun-Xia Li, Hua-Ming Li, Department of Gastroenterology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Lei Lu, Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Informed consent statement: The patient and her family provided informed written consent.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hua-Ming Li, MAMS, Doctor, Department of Gastroenterology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, No. 548 Binwen Road, No. 38 West Lake Road, Hangzhou 310000, Zhejiang Province, China.
Telephone: +86-571-87823158
Received: March 25, 2018
Peer-review started: March 25, 2018
First decision: April 26, 2018
Revised: June 18, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: September 6, 2018

Acute pancreatitis is rarely associated with drugs. Acetaminophen overdose is a well-known cause of hepatic toxicity, but drug-induced pancreatitis is rarely reported, especially after mild overdose. A 32-year-old woman presented with nausea and vomiting for 12 h, but no abdominal pain following an overdose of eight Tylenol tablets containing acetaminophen (325 mg acetaminophen per tablet). Laboratory results on admission showed abnormal amylase and lipase levels but completely normal liver function. Magnetic resonance cholangiopancreatography revealed mild swelling of the pancreas without fluid collection around the pancreas. The patient complained of severe abdominal pain five days after admission when attempting to drink water and liquids. Eight days after admission, fluid around the pancreas was observed by computed tomography. The patient was subsequently diagnosed with acetaminophen-induced acute pancreatitis after exclusion of common causes. Routine treatment for pancreatitis and N-acetylcysteine were administered to prevent disease progression. The patient was discharged in good condition.

Keywords: Pancreatitis, Cholangiopancreatography, Acetaminophen, Acute pancreatitis, Drug-induced acute pancreatitis

Core tip: This case shows that a dose of acetaminophen of less than 4 g can cause acute pancreatitis without liver damage, and that the mechanism of pancreatitis is different from that of hepatitis, and acetaminophen-induced acute pancreatitis may not be related to the drug dose. Although drug-induced acute pancreatitis is rare and the detailed underlying mechanism is unknown, physicians should consider this etiology after ruling out other causes of pancreatitis, especially in young women who are at high risk of overdosing on Class I and Class II drugs.