Probable loop diuretic-induced pancreatitis in a sulfonamide-allergic patient

The Annals of Pharmacotherapy
Paul JuangRonald Zolty

Abstract

To report the case of a patient with a prior allergy to a sulfonamide antibiotic who subsequently developed the same reaction when administered various loop diuretics. A 57-year-old female with cardiomyopathy and "sulfa" (trimethoprim/sulfamethoxazole) allergy documented as pancreatitis presented with symptoms consistent with pancreatitis after use of furosemide. She subsequently developed similar symptoms after multiple rechallenges with various loop diuretics including furosemide, bumetanide, and torsemide. The patient was placed on ethacrynic acid until she was desensitized to furosemide. She had been receiving oral furosemide for 5 months at the time of this report, with no complications. According to the Naranjo probability scale, this reaction was probable. Reactions associated with arylamine sulfonamide-containing antibiotics have been commonly reported; however, cross-reactions with non-arylamine sulfonamide-containing medications have been rare. The time delay by which symptoms of pancreatitis presented following administration of loop diuretics suggests an immunologic pathway. In addition, while cases of loop diuretic-induced pancreatitis, including furosemide, have been published, the allergic manifestations with bot...Continue Reading

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Citations

Nov 24, 2017·BMJ Case Reports·Ben-Jiang Ma
Aug 15, 2013·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Nicole R Wulf, Karl A Matuszewski
Sep 2, 2008·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Anil R Balani, James H Grendell
Jun 27, 2020·World Journal of Gastroenterology : WJG·Simcha WeissmanJames H Tabibian
Feb 25, 2020·Journal of Medicinal Chemistry·Falgun Shah, Ian M Bell

Related Concepts

Drug Allergy
Cardiomyopathies
Pancreatitis
Sulfonamides
Loop Diuretics

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