Case 4: Didanosine-Associated Pancreatitis

Question | Discussion | References | CME Credit

You answered:

	Didanosine causes pancreatitis by directly activating the pancreatic enzyme trypsinogen.

This answer is incorrect. Although the exact mechanism of didanosine-induced pancreatitis remains unknown, there is no evidence that didanosine directly activates pancreatic zymogens. The leading hypothesis suggests that didanosine can cause mitochondrial toxicity by inhibiting mitochondrial DNA polymerase-gamma, a mechanism also thought to explain didanosine-induced myopathy, neuropathy, and lactic acidosis.

Choose another answer:

	More than 90% of cases of didanosine-associated pancreatitis result from didanosine-induced hypertriglyceridemia.
	Didanosine-associated pancreatitis usually occurs within the first two weeks of therapy; the timing of pancreatitis in this patient is highly unusual.
	The risk of didanosine-induced pancreatitis is dose-related. The patient in this case had an increased risk of developing pancreatitis because tenofovir DF likely increased didanosine levels. The didanosine dose should have been decreased to 250 mg per day.
	In order to decrease her risk of pancreatitis, didanosine should have been combined with stavudine (Zerit) and hydroxyurea (Hydrea).

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