C LEE 1, 2N RAO
1 Renal Unit, Flinders Medical Centre, Bedford Park, Australia 2 Renal Unit, Flinders Medical Centre, Renal Unit Lyell McEwin Hospital, Bedford Park, Australia
Background: Acute pancreatitis remains a challenging yet treatable condition which can result from numerous well-known causes. In the setting of pancreas transplant, pancreatic graft rejection or thrombosis should always be considered prior to attributing it to another aetiology. Gadolinium induced pancreatitis, is a rare phenomenon associated with the administration of gadolinium-based contrast agent (GBCA), with 5 such cases reported worldwide so far in patients with native kidney and pancreas.
Case Report: In this article, we present a 32 years-old woman with prior history of simultaneous pancreas kidney (SPK) transplant who presented with generalised abdominal pain associated with systemic inflammatory response syndrome (SIRS) requiring admission to intensive care unit (ICU) with marked rise in serum lipase and computed tomography (CT) findings consistent with acute pancreatitis. This occurred within 48 hours after she underwent Magnetic Resonance Imaging (MRI) with GBCA, Gadobutrol (Gadovist) for investigation of subacute left optic atrophy. Other causes of pancreatitis were ruled out. She was managed with aggressive hydration, bowel rest and analgesia with good recovery.
Conclusion: This is the first such reported case of the occurrence of gadolinium induced pancreatitis in a pancreas kidney transplant recipient. The increasing incidences of gadolinium induced pancreatitis challenges the current understanding that magnetic resonance imaging is safer than computer tomography.
Dr Chiang Sheng Lee graduated from Monash University in 2012 and commenced his career in Malaysia working as house officer for two years and subsequently a year as medical officer in medical department in East Malaysia. He moved to Adelaide as a general trainee in 2016 before pursuing physician training in 2018 at Lyell McEwin Hospital. He is currently a first year nephrology trainee at Flinders Medical Centre. He has also completed Masters of Science in Internal Medicine from University of Edinburgh.