GLP1s: Hidden Menace! Novel Chronic Medication Regimen Leads to Pancreatopleural Fistula and Tube Feed Effusion

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Drug induced pancreatitis is related to many therapeutic regimens for common chronic issues. With the increase in popularity of GLP1 use, many patients are on multiple medications that are known to contribute to the development of pancreatitis. Occasionally, severe pancreatitis can lead to necrosis, cyst formation, and formation of fistulas that potentiate critical care and severe morbidity. Here we present a patient with a severe complication of pancreatitis caused by a GLP-1 We have a 69 year old male with history of recent acute necrotizing pancreatitis s/p cyst gastrostomy stent placement, T2DM on mounjaro, and HTN on hydrochlorothiazide who was recently treated with doxycycline for a left side abscess, who presented with epigastric pain radiating to his back and found to have recurrent pancreatitis. His hospital course was complicated by PEA arrest in the setting of worsening septic shock. Blood cultures became positive for Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Streptococcus anginosus, and Candida albicans. He was treated with a long course of Ertapenem, Linezolid and fluconazole. Due to worsening abdominal pain, the patient had abdominal C-ray that incidentally noted a large left sided effusion. The patient underwent thoracentesis that found purulent fluid and he had a chest tube placed. Effusion continued to drain what was thought to be the patient's tube feeds. Repeat CT scan showed pancreaticopleural fistula. Cardiothoracic surgery was consulted and recommended no acute intervention. However due to the patient's persistent empyema, he was taken to the operating room for a video-assisted thoracoscopic surgery with decortication. Due to the pancreaticopleural fistula and developing SBO, patient was transitioned to total parenteral nutrition. Patient was able to be extubated however he subsequently had respiratory failure requiring a tracheostomy. After a long ICU stay, patient was able to be discharged to a long-term acute care hospital. GLP1's have improved control of diabetes and have increased in popularity, however, long-term risks of chronic use are unknown. There exists inconsistent data regarding risk of acute pancreatitis related to GLP1RAs. Some studies suggest increased risk with regimens that include exenatide, sitagliptin, and liraglutide while others show no association with increased risk or only a slight risk. One such consideration would be to better understand the cumulative risks for development of pancreatitis in the setting of therapeutic regimens that include multiple drugs known to increase risks. Additionally, investigating the incidence of fistulaization to better understand severity of side effects related to GLP1 induced pancreatitis.

Volume

211

First Page

A3822

Last Page

A3822

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A3822

ISSN

1535-4970

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