Severe rhabdomyolysis induced by bezafibrate in the treatment of severe acute pancreatitis with hyperlipidemia: A case report

Abstract

Rationale: The important etiological treatment for hyperlipidemic severe acute pancreatitis is to reduce blood lipid. Statins or fibrates are often selected in clinical practice. Most reports indicate that statins or statin combination therapy can cause serious complications such as rhabdomyolysis syndrome (RM) and even poor prognosis. However, in fact, RM may also occur when fibrates alone are used to reduce blood lipid.

Patient concerns: A 25-year-old man was admitted to our hospital for a 2-day history of abdominal pain, nausea, and vomiting. This patient presented with typical clinical manifestations of acute pancreatitis such as abdominal pain, abdominal distension, nausea, vomiting, and difficulty in defecation after a greasy diet. Auxiliary examinations such as blood (urine) amylase, lipase, blood lipid, abdominal computed tomography, and color Doppler ultrasound confirmed hyperlipidemic severe acute pancreatitis. However, after admission, during the treatment for reducing blood lipid, the blood creatine kinase index of the patient continued to increase, reaching more than 200 times the upper limit of normal at the highest. Accompanied by typical clinical manifestations, rhabdomyolysis was considered. After discussions among experts in the department, differentiations were mainly made from drugs after admission, recent history of toxicant exposure, history of trauma, past history of similar rhabdomyolysis, and other etiologies causing elevated myocardial enzyme spectrum. Finally, it was considered related to bezafibrate.

Diagnoses: RM.

Interventions: Bezafibrate tablets for lowering blood lipids were immediately discontinued. On the second day after discontinuation, there was a small decrease in creatine kinase. Then, appropriate fluid infusion, alkalinization of urine, addition of plasma exchange, and bedside continuous renal replacement therapy were administered.

Outcomes: The level of muscle enzymes decreased progressively and finally returned to normal before discharge.

Lessons: In clinical practice, it is necessary to dynamically monitor the changes of liver and kidney functions and myocardial enzyme spectrum when using bezafibrate tablets to treat hyperlipidemic pancreatitis.

Keywords: bezafibrate; case report; hyperlipidemia; rhabdomyolysis syndrome; severe acute pancreatitis.

Figure 1.

Enhanced CT of the upper abdomen: pancreatic edema, necrotic exudation around the pancreas and around the left kidney, fatty liver or hepatic edema. CT = computed tomography.

Figure 2.

Changes in CK after admission. The dotted line indicates the time when bezafibrate tablets were discontinued. CK = creatine kinase.