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Late and severe acute necrotizing pancreatitis in a patient with liraglutide.

Liraglutide is the second synthetic analogue of human glucagon-like peptide-1(GLP-1) marketed after exenatide for the treatment of type 2 diabetes. The most frequently reported side effects with this treatment are gastrointestinal (nausea, diarrhea, vomiting, constipation and dyspepsia), headaches and rhinopharyngitis are also frequent. These symptoms often resolve spontaneously within a few days or weeks. [1] The use of analogues of GLP-1 has been reported to be a risk of pancreatitis, however its frequency could not be estimated because of the rarity of published cases.[2,3] The most common causes of pancreatitis are gallstones and alcohol (80% of cases).[4] Other causes include metabolic disorders (hypertriglyceridemia, hypercalcemia), infections (viral, bacterial, fungi or parasitic), tumors (pancreatic duct obstruction), vascular diseases (ischemia and vasculitis), autoimmune diseases, genetic, toxic (scorpion venom), trauma. Pancreatitis can also be idiopathic. Drug induced pancreatitis is relatively rare with an estimated incidence between 0.1 to 2%.[4,5] The time of onset of pancreatitis may vary from a few weeks to several months of exposure, probably due to the accumulation of toxic metabolites.[6] We report a case of severe necrotizing acute pancreatitis after 11 months of treatment with liraglutide for type 2 diabetes.