Acute Pancreatitis Associated with Metabolic, Infections and Drug‐Related Diseases

Most frequently acute pancreatitis is caused by alcohol abuse, by migrating gallbladder stones or no etiological agent can be identified despite extensive diagnostics (idiopathic pancreatitis). Rare cases of acute pancreatitis are metabolic disorders, drugs, and infectious agents and their estimated incidence is less than 10% of all cases. The most common metabolic diseases in this context are hypertriglyceridemia, often observed in association with diabetes mellitus or hyperlipidemia, and hypercalcemia as a result of primary hyperparathyroidism. Acute pancreatitis can also arise in association with diabetic ketoacidosis but is then often attributed to co-occurring hypertriglyceridemia. More than 500 drugs have been reported to cause acute pancreatitis and their number is increasing. Data are mostly based on case reports with an inconsistent quality of evidence. The probability of drug-associated pancreatitis can be estimated using classification systems often requiring a reasonable temporal relationship from drug intake to the onset of pancreatitis and recurrence of disease after drug re-exposure. Mumps virus is the most extensively described infectious agent causing acute pancreatitis. Other viruses as well as bacteria, parasites, and fungi are rare causes of acute pancreatitis. Generally, treatment does not differ from other types of pancreatitis. Correction of triglyceride and calcium levels as well as drug withdrawal or antimicrobial treatment is done depending on the underlying disorder. Parasites impacted in the duodenal papilla and impairing the flow of pancreatic juice require endoscopic removal just as impacted gallstones do.