We report two cases of acute pancreatitis following the administration of pamidronate given as an anti-inflammatory agent for spondyloarthritis with a recurrence in one patient when the drug was reintroduced. The upper gastrointestinal toxicity of aminobisphosphonates is well known and this drug class could be added to the list of medications that are associated with the development of pancreatitis.
Drugs are a relatively uncommon cause of acute pancreatitis (AP) [
A 70-year-old white male with a 40-year history of ankylosing spondylitis (AS) was referred to our hospital for abdominal pain. His AS had been treated previously by different NSAIDs with a progressive lack of efficacy. He had a past medical history of dyslipidemia treated by fenofibrate for more than ten years, two episodes of AP without any identified cause, and prostate cancer, a contraindication to use anti-TNF
The second patient was a 39-year-old white female with peripheral arthritis and inflammatory back pain related to spondyloarthritis. She received NSAIDs, sulfasalazine, and methotrexate successively, all of which were ineffective. She developed infections under adalimumab. Due to persistent back pain, pamidronate was started in August 2009. She received six pamidronate infusions, 60 mg monthly, leading to progressive improvement. Three weeks after the third infusion, she complained of abdominal pain with elevated serum lipase (184 UI/L; N < 60) and AP was seen on injected CT scan of the abdomen (CTSI 2). Microlithiasis was observed on abdominal ultrasound and the patient thus underwent laparoscopic cholecystectomy surgery. She had two other episodes of AP without receiving pamidronate and a nonmalignant caudal pancreatic tumor was then diagnosed in 2010 (glucagonoma). This tumor was removed by surgery and pamidronate treatment was restarted in 2011. Five days after the third infusion, she again had AP diagnosed on a CT scan of the abdomen (Figure
The safety profile of pamidronate is well described, with acute-phase reaction following its administration but no evident abdominal organ toxicity [
The authors declare that they have no conflict of interests.