Fatal case of acute necrotic pancreatitis secondary to chronic abuse of acetaminophen: a case report

Abstract

Acetaminophen is a widely used analgesic and antipyretic. It is also known to cause hepatotoxicity and is rarely associated with acute pancreatitis due to overdose. We report the case of a 55-year-old man with no known comorbidities, who presented with severe abdominal pain and vomiting. His medication history revealed chronic abuse of a fixed-dose combination containing 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen 3-6 tablets per day for over 20 years for general body pain without a specific diagnosis. He was diagnosed with acetaminophen-induced acute necrotic pancreatitis after ruling out gallstones and other factors such as alcohol consumption, and family history. Although he got discharged against medical advice, follow-up revealed that he had succumbed to his illness within 15 days. This was a fatal case of acetaminophen-induced pancreatitis due to chronic abuse for over 20 years at a dose of less than 2 g/day. This case highlights the need for periodic monitoring of patients taking acetaminophen at doses within the recommended daily dose.