A Case Report on Acute Pancreatitis Associated with Sitagliptin Therapy in Type 2 Diabetes Mellitus

Case Report

Abstract

Acute pancreatitis is a rare but clinically significant adverse drug reaction associated with incretin-based therapies. A 58-year-old male with a 10 year-long history of type 2 diabetes mellitus experienced a sudden onset of severe epigastric pain, nausea, and vomiting exactly fourteen days after the addition of sitagliptin to a long-term regimen of metformin and rosuvastatin. Diagnostic evaluation revealed serum amylase levels of 420 U/L and lipase levels of 780 U/L, while contrast-enhanced computed tomography confirmed diffuse pancreatic enlargement and peripancreatic inflammatory changes. The exclusion of gallstones, alcohol consumption, and hypertriglyceridemia pointed toward a drug-induced etiology. Immediate cessation of sitagliptin coupled with aggressive fluid resuscitation and analgesic therapy resulted in the rapid resolution of symptoms and normalization of biochemical markers within 72 hours. While dipeptidyl peptidase-4 inhibitors offer excellent glycemic control with minimal hypoglycemia, the potential for pancreatic acinar cell injury and ductal proliferation remains a subject of ongoing pharmacovigilance. Early clinical recognition of epigastric distress in patients newly started on incretin mimetics is vital for preventing progression to necrotizing pancreatitis or systemic inflammatory response syndrome. This case shows the need for diligent post-marketing monitoring and the role of clinical suspicion in managing unanticipated adverse events in diabetic patients