Recurrent pancreatitis induced by metronidazole re-exposure and a review of the current literature

Metronidazole is the drug of choice used to treat parasitic infections, infections caused by anaerobic bacteria, Helicobacter pylori, inflammatory bowel diseases, and Clostridium difficile colitis. It is well distributed into body tissues and effectively penetrates the blood-brain barrier. Acute pancreatitis is an inflammatory disease with a wide spectrum of severity, characterized by high levels of amylase and lipase (1). Severe epigastric pain of acute onset often radiating through the back is the main alarming symptom. Pancreatitis is a very rare adverse effect and only nine cases of metronidazole-induced pancreatitis have been reported in the English literature so far (Table 1) (2-10). We report a case of recurrent acute pancreatitis associated with oral metronidazole therapy for an episode of ulcerative colitis and C. difficile colitis.