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  1. Tigecycline-Induced Acute Pancreatitis with Electrocardiogram Changes in Renal Insufficiency Elderly
    Wee HC, Ng RS, Ong LM
    Eur J Case Rep Intern Med, 2024;11(12):005033.
    PMID: 39790845 DOI: 10.12890/2024_005033
    BACKGROUND: The prevalence of multidrug-resistant and extensively drug-resistant pathogens has led to increased reliance on broad-spectrum antimicrobials, such as tigecycline. This medicine is commonly used to treat complicated skin and intraabdominal infections as well as community-acquired pneumonia. However, the increasing use of tigecycline has been linked to serious complications, including acute pancreatitis.

    CASE DESCRIPTION: We present a case of tigecycline-induced acute pancreatitis in a 78-year-old man with complex medical conditions, including type 2 diabetes mellitus, chronic renal insufficiency, and triple vessel disease. The patient was initially treated with tigecycline for bilateral dry gangrene of his toes. Six days after initiation of the tigecycline treatment, the patient developed symptoms of acute pancreatitis with electrocardiogram changes. Magnetic resonance imaging confirmed the diagnosis of acute pancreatitis. Tigecycline was stopped promptly, and supportive treatment was initiated. The patient recovered from the acute pancreatitis and was discharged home. He later passed away at home due to his underlying cardiac disease.

    CONCLUSIONS: This case highlights the potential complications of tigecycline therapy, particularly in patients with significant comorbidities.

    LEARNING POINTS: Elderly patients with complex medical issues, such as diabetes mellitus type 2, chronic renal insufficiency, and cardiovascular disease, are at higher risk for adverse drug reactions. Recognizing these risk factors is important for management.Addressing the use of magnetic resonance imaging for diagnosing acute pancreatitis in this specific patient due to their already compromised kidneys highlights the need for a tailored approach. Most commonly, angiographic transformers or computed tomography scan are used for high-risk patients.The symptoms of acute pancreatitis and the presence of cardiac diseases cause problems in managing patients. Changes on the electrocardiogram may suggest cardiac overload; as a result, constant follow-up is necessary for patients suffering from underlying cardiac conditions.

  2. Fulltext Recurrent Cardiac Tamponade as a Complication of Prolonged Left Bundle Branch Area Pacing
    Kamarulzaman N, Wan Abdullah WNA, Othman MK, Isa WYHW, Yusof Z, Mohamad Jamali AA, et al.
    Eur J Case Rep Intern Med, 2025;12(2):005144.
    PMID: 39926563 DOI: 10.12890/2025_005144
    Post-cardiac injury syndrome (PCIS) is one of the complications of cardiac interventional procedures. This condition has been postulated to be due to an immune reaction, especially with pacemaker lead implantation. Patients with PCIS can have uncomplicated pericardial effusion until they develop cardiac tamponade. The management of PCIS, which can be conservative management or require pericardiocentesis or surgery depends on the patient's clinical symptoms. As the left bundle branch area pacing (LBBAP) implantation technique and technology are still new, it is associated with longer procedural time than conventional pacemaker implantation. Herein, we report a case of PCIS in a patient who had a prolonged LBBAP procedure due to difficult anatomy and presented with recurrent cardiac tamponade.

    LEARNING POINTS: Prolonged fluoroscopy in cardiac procedures can potentially lead to post-cardiac injury syndrome.Active pacemaker lead fixation is one of the risk factors for post-cardiac injury syndrome due to immune reaction.Left bundle branch area pacing in adults with congenital heart disease is challenging because of anatomical differences.

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