Retinoids are vitamin A derivatives with numerous indications in dermatology. Acute pancreatitis is a rare adverse effect of systemic retinoids. We report a case occurring during acitretin treatment for psoriasis.
A 27-year-old male patient with no history of diabetes, obesity, alcohol consumption or medication consulted for extensive pustular psoriasis. The lipid balance and liver tests were normal. The patient was treated with acitretin at a dose of 25mg/d. Four days after the start of treatment, the patient was admitted to the surgical emergency room for piercing epigastric pain with vomiting of bile, without transit problems. Serum lipase was 20 times the normal value (1278 IU/L). CRP was raised at 155mg/L and triglycerides were normal at 0.66g/L. Ranson's score was 1 and the abdominal scan revealed Balthazar Grade B pancreatitis with a small amount of peritoneal effusion. The ultrasound examination showed absence of gall stones, without dilation of either the intra- or extra-hepatic bile ducts. Acitretin was discontinued due to its possible causative role. The patient was treated by means of parenteral feeding, strict fasting and a proton-pump inhibitor, and a good clinical outcome with gradual normalization of serum lipase and CRP was achieved in 10 days. The patient was subsequently treated with infliximab for psoriasis, with good results.
In the event of acute abdominal pain in a patient treated with retinoids, a diagnosis of acute pancreatitis should be considered. This complication can occur in the absence of hypertriglyceridemia.