Atorvastatin

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case series of 3 patients, an 87-year-old woman was described, who developed acute pancreatitis during treatment with atorvastatin for hyperlipidaemia.

The woman presented to the emergency department with generalised abdominal pain with suprapubic tenderness, and nausea along with two episodes of vomiting. Two weeks prior to presentation, she was diagnosed with COVID-19. However, she had tested negative for COVID-19 two days prior to presentation. She had received clarithromycin and amoxicillin/clavulanic-acid [co-amoxiclav] for chest crepitations; however, it was switched to piperacillin/tazobactam [tazocin], as her inflammatory markers were progressively increased. She had a significant history of hyperlipidaemia, congestive heart failure, atrial fibrillation, hypertension, dementia, diverticular disease and cholecystectomy. She had been receiving low dose of atorvastatin [route and dosage not stated] for the management of hyperlipidaemia. Upon presentation, a physical examination was performed which showed soft abdomen, tender in the epigastrium and left upper quadrant. A chest auscultation examination showed bibasal crepitations. Her laboratory investigations showed an elevated serum amylase (499U/L), C-reactive protein (128 mg/L) and triglyceride levels (2.24 mmol/L). Her lactate dehydrogenase (LDH) level was 231U/L, and liver function tests were within normal ranges. Subsequent computed tomography (CT) scan of the abdomen and pelvis showed acute pancreatitis and fibrotic changes in the lung bases bilaterally. It was concluded that, she had developed acute pancreatitis due to atorvastatin therapy, elevated triglyceride levels and COVID-19 infection [duration of treatment to reaction onset not stated]. Additionally, she was found have acute urinary retention.

The woman started receiving treatment with intravenous fluids. Additionally, her oral diet slowly re-introduced. Her symptoms resolved following the corrective measures. A nasopharyngeal swab prior to discharge showed a negative result for COVID-19. After 5 days of hospital stay, she was discharged from the hospital. After few months, she was hospitalised again due general health deterioration. A magnetic resonance cholangiopancreatography (MRCP) was performed which showed no stones in the biliary tree.