Idiopathic and Metabolic Triggers Leading to Recurrent Acute Pancreatitis in a 30-Year-Old Woman

Abstract

Background: Recurrent acute pancreatitis can be influenced by a variety of factors, including metabolic and lifestyle triggers. This case report presents a 30-year-old Asian woman whose episodes of pancreatitis were complicated by hypertriglyceridemia, Type 2 diabetes mellitus (T2DM), and occasional alcohol use. Medication-related risks, such as semaglutide, were also identified as possible contributors. Case Presentation: The patient experienced three distinct episodes of acute pancreatitis. Initially admitted in June 2020, she presented with no prior medical history and denied alcohol use. During subsequent admissions in April 2023 and January 2024, the patient reported alcohol consumption. The second admission showed significantly elevated triglyceride (TG) levels (>5680 mg/dL), and the third occurred after New Year’s Eve alcohol consumption, with TG >3000 mg/dL. Treatment across all episodes involved NPO status, IV fluids, and ICU admission with insulin therapy to lower TG levels. After the recurrence of pancreatitis, her T2DM treatment was changed from semaglutide to dapagliflozin. Conclusion: This case underscores the importance of comprehensive patient education on lifestyle factors, medication risks, and adherence to treatment plans to reduce the recurrence of acute pancreatitis. Tailoring interventions, such as switching diabetes medications (from semaglutide to dapagliflozin) and emphasizing TG management through gemfibrozil, atorvastatin, and icosapent ethyl, proved essential in stabilizing her condition. The patient’s case serves as a reminder of the multiple potential causes of pancreatitis and the need for ongoing monitoring to prevent further complications.