Critical Care SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 CEPHALEXIN-ASSOCIATED ACUTE PANCREATITIS: A CASE REPORT AND LITERATURE REVIEW IMAMA AHMAD USAMA TALIB AND SOHAIB ANSARI INTRODUCTION: Acute pancreatitis (AP) causes over 230,000 hospitalizations per year in the United States.[1] Most important etiologies include gallstones (40%), alcohol (40%), hypercalcemia, and hypertriglyceridemia. Drug induced pancreatitis(DIP) is rare (0.1–2% of cases), and occasionally can be life threatening if not timely diagnosed and treated.[2] We report a rare case of acute pancreatitis in the setting of cephalexin use. CASE PRESENTATION: Patient was an 82 year old female with a history of fibromyalgia, diabetes on insulin and deep venous thrombosis who presented to the emergency department with sudden onset excruciating epigastric pain. Vitals were notable for mild fever and tachycardia and physical examination demonstrated epigastric tenderness radiating to the back. Laboratory tests were pertinent for leukocytosis and elevated serum lipase of 5980U/L. Toxicology screen, LFTs, triglycerides were within normal limits. CT scan of the abdomen revealed extensive inflammatory changes surrounding the entire pancreatic parenchyma, most notably the body and the tail with no signs of choledocholithiasis. History revealed she was started on Cephalexin 3 days ago for a UTI. Extensive workup excluded all other etiologies of pancreatitis in this patient. Cephalexin was discontinued and the patient was managed with intravenous(IV) fluids and analgesics leading to resolution of symptoms. Extensive infectious workup was negative, right upper quadrant ultrasound and MRCP showed acute interstitial pancreatitis without any papillary stenosis. CONCLUSIONS: Cephalexin is a rare cause of acute pancreatitis. The authors write to create awareness about this rare and relatively unknown but severe side effect of cephalexin. Reference #1: Peery, A.F., et al., Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 2012. 143(5): p. 1179-1187 e3. Reference #2: Wolfe, D., et al., Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations. PLoS One, 2020. 15(4): p. e0231883. Reference #3: Wolfe, D., et al., Methods for the early detection of drug-induced pancreatitis: a systematic review of the literature. BMJ Open, 2019. 9(11): p. e027451. DISCLOSURES: No relevant relationships by Imama Ahmad, source¼Web Response No relevant relationships by Sohaib Ansari, source¼Web Response No relevant relationships by Usama Talib, source¼Web Response DOI: http://dx.doi.org/10.1016/j.chest.2020.08.918 Copyright ª 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. chestjournal.org 987A CRITICAL CARE DISCUSSION: Hospitalizations secondary to acute pancreatitis are common globally and need prompt diagnosis and etiology specific treatment. Multiple drugs have been associated with development of AP, most common drugs include sulfa-containing drugs, valproic acid, ASA, tetracyclines and didanosine. Clinical features of drug related AP are similar and rash, eosinophilia, or lymphadenopathy is rarely seen. Management includes discontinuation of the culprit drug, IV fluids and pain control. The authors report a case of AP in the setting of cephalexin use, a drug with only six cases of AP reported so far. Drugs associated with pancreatitis are divided into 4 classes based on degree of association with pancreatitis.[3] The criteria of causation is established by drug induced pancreatitis-specific causality algorithms that measure timing of onset of symptoms, resolution of clinical and laboratory abnormalities on withdrawal of the drug, recurrence on re-administration of the drug and exclusion of other non-drug induced pancreatitis.[3] Though establishment of causality is difficult, etiological identification is necessary for effective management and prevention of complications.