Pancreatitis due to Clomiphene Citrate-Induced Hypertriglyceridemia: A Case Report and Literature Review

ABSTRACT Objective: Clomiphene citrate-induced hypertriglyceridemia causing acute pancreatitis is rare. The aim of this case report is to alert physicians to the possibility of clomiphene citrate-induced hypertriglyceridemia that can lead to acute, and even chronic, pancreatitis. Methods: We describe a patient with known mild hypertriglyceridemia who presented with acute pancreatitis and severe hypertriglyceridemia after initiation of clomiphene citrate. Results: The patient had mid-epigastric tenderness with radiation around her bilateral flanks in a band-like distribution. Lab studies showed a triglyceride level greater than 4,425 mg/dL, a lipase level greater than 3,000 U/L, and computed tomography of the abdomen showed acute interstitial edematous pancreatitis. The patient's Naranjo Adverse Drug Reaction score was calculated to be a 7, and was therefore probable as clomiphene being the causative agent. The patient's triglyceride levels improved after initiation of fibrate therapy and discontinuation of clomiphene at first; however, she continued to develop acute episodes of pancreatitis that progressed to chronic pancreatitis despite stopping clomiphene citrate. This is the second report of recurrent pancreatitis with hypertriglyceridemia induced by clomiphene citrate and, in this case specifically, each episode of pancreatitis was associated with hypertriglyceridemia. Conclusion: Clomiphene citrate-induced hypertriglyceridemia rarely occurs and can progress to acute, and even chronic, pancreatitis with significant morbidity. Clomiphene citrate should be used with caution in patients with elevated triglycerides, and should be avoided in patients with triglyceride levels greater than 400 mg/dL.