Ozempic induced pancreatitis leading to respiratory failure and severe ARDS

Abstract

We report a rare and severe case of semaglutide-associated acute pancreatitis complicated by viral pneumonia and progression to acute respiratory distress syndrome (ARDS). A 37-year-old woman with type 2 diabetes, obesity, and multiple comorbidities presented with worsening epigastric pain radiating to the back, nausea, and vomiting. Imaging and a lipase level >3000 U/L confirmed acute pancreatitis. No evidence of gallstones, alcohol use, or hypertriglyceridemia was found. The only recent medication change was the addition of semaglutide (Ozempic), raising suspicion for drug-induced pancreatitis.

Despite initial stabilization, the patient developed a dry cough and tested positive for coronavirus 229E and parainfluenza 3. She experienced progressive hypoxia, evolving into severe ARDS requiring intubation, prone positioning, corticosteroids, and lung-protective ventilation. Chest imaging revealed diffuse bilateral infiltrates, and arterial blood gases confirmed a P/F ratio <50. The patient received ICU-level care including sedation, neuromuscular blockade, and supportive therapy, eventually improving and being extubated to BiPAP, then discharged to rehabilitation.