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Clinical Case Report of Familial Benign Pancreatic Hyperenzymemia.

levels were 7800 μL, 11.94 mg/dL, 212 IU/L, and 72.6 IU/L, respectively. Despite abnormal pancreatic enzyme levels, she was able to tolerate food intake on admission day 12 without recurrence of acute pancreatitis. Endoscopic ultrasonography revealed no evidence of metastasis to the pancreas. Subsequently, the patient was closely followed up with radiological and abdominal CE-CT scanning. During follow-up, the size of the pancreatic pseudocyst and splenic pseudoaneurysms did not showa decrease. She was eventually discharged on normalization of the pancreatic enzymes and switched to sorafenib once stable. Common adverse events of lenvatinib include hypertension, diarrhea, and proteinuria and are manageable with dose modification or interruption. Hyperamylasemia or hyperlipasemia are also well-known adverse events of multikinase inhibitors. However, the frequency of acute pancreatitis is low, and the association between hyperamylasemia/heperlipasemia and acute pancreatitis during multikinase inhibitors administration is still unknown. The severity of acute pancreatitis is usually mild, focal, and managed conservatively by discontinuation of the multikinase inhibitors. Most focal pancreatitis is developed in the pancreatic tail for undetermined reasons. To our knowledge, this is the first report of lenvatinib-induced acute pancreatitis. Fortunately, in this case, we have achieved improvements in the management of severe acute pancreatitis. The mechanism of lenvatinib-induced acute pancreatitis is unclear but is hypothesized to be similar to that of other multikinase inhibitors, which induce microvascular ischemia followed by release of autolytic enzyme and inhibition of gastrointestinal motility. Although the diagnosis of drug-induced acute pancreatitis is sometimes difficult, the oncologist should recognize acute pancreatitis as a possible adverse event of lenvatinib treatment. In conclusion, the findings described herein suggest that more attention should be paid to regular monitoring of pancreatic enzymes during lenvatinib treatment. Further investigation is needed to determine the precise incidence, background characteristics, and risk factors underlying lenvatinib-induced acute pancreatitis.