Black elderberry extract induced acute pancreatitis- A case report

Dr Simcha Weissman at Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA and colleagues have reported a rare case of Black elderberry extract induced acute pancreatitis. The case report has been published in the journal Digestive Diseases and Sciences.

The patient presented to the emergency department (ED) after experiencing sudden sharp abdominal pain after using a herbal product containing black elderberry extract (Sambucol). He reported that previous use of the same agent had resulted in a similar episode, but the pain had resolved on its own. The patient denied use of any other medications and had no significant history of alcohol abuse.

In the ED, an ultrasound was conducted and ruled out gallstones. Lab testing revealed a serum lipase level of 407mg/dL (upper limit of normal 84mg/dL), while a CT scan showed “pancreatic inflammation with peripancreatic fat stranding.” Additional labs were all found to be unremarkable.

The patient was admitted to the hospital where his abdominal pain persisted despite supportive care. He was administered intravenous methylprednisolone after a CT scan showed “thickening of the descending and sigmoid colon suggestive of colitis as well as bilateral pleural effusions.” Following 3 days of steroid treatment and a total of 6 days in the hospital, he was discharged with an oral steroid taper and advised to stay away from products containing black elderberry extract.

Using the Naranjo Adverse Drug Reaction Probability Scale, the authors calculated a score of 9 for this case, which indicated that black elderberry was the definite cause of acute pancreatitis in this patient. “This represents, to our knowledge, the first case of black elderberry-induced acute pancreatitis and serves to illustrate the importance of maintaining a broad differential and taking a thorough history, including homeopathic and other alternative remedies, in patients presenting with acute pancreatitis of unclear etiology,” they concluded.

This is a rare case of black elderberry-induced acute pancreatitis and serves to emphasize the importance of maintaining a broad differential and taking a thorough history, including adverse effect of drugs.