Acute Pancreatitis Caused by Pegylated (PEG)-Asparaginase Associated With Severe Hypertriglyceridemia

TL;DR

A patient with leukemia developed pancreatitis and high triglycerides after treatment with PEG-asparaginase, highlighting a rare but serious side effect.

Contribution

This case report highlights the rare but significant co-occurrence of pancreatitis and hypertriglyceridemia caused by PEG-asparaginase.

Findings

An 18-year-old B-ALL patient developed acute pancreatitis and severe hypertriglyceridemia after PEG-asparaginase treatment.

Conservative management and insulin infusion were used to treat pancreatitis and hypertriglyceridemia, respectively.

The study suggests a need for further research to understand and prevent these adverse effects.

Abstract

Pegylated (PEG)-asparaginase is used during the induction and intensification phases of treatment for B-cell acute lymphoblastic leukemia (B-ALL). It works by depleting the external sources of asparagine, causing the death of lymphoblasts. It has several adverse effects, including pancreatitis and hypertriglyceridemia; however, the simultaneous occurrence of both is uncommon. We present the case of an 18-year-old man with B-ALL who developed acute epigastric pain radiating to the back and non-bloody, non-bilious emesis following treatment with PEG-asparaginase. He was diagnosed with acute interstitial pancreatitis and severe hypertriglyceridemia. Conservative management was used for the pancreatitis, while hypertriglyceridemia was treated with an insulin infusion. Pancreatic toxicity and hypertriglyceridemia can necessitate the discontinuation of PEG-asparaginase, limiting treatment options and potentially increasing the risk of relapse. Therefore, further studies are needed to identify the factors contributing to hypertriglyceridemia and pancreatitis, aiding clinicians in monitoring and prevention.

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