Why now? Delayed drug-induced pancreatitis due to dapsone for dermatitis herpetiformis.

Drug-induced pancreatitis can be caused by a wide array of medications. In fact, the diagnosis is likely commonly missed due to the difficulty in diagnosing one agent as the sole cause. We present a case of dapsone-induced pancreatitis in a 75-year-old male with history of celiac disease. He presented with abdominal pain and was found to have acute pancreatitis. Interestingly, he had been on dapsone for 5 years and had no other recent medication changes, significant alcohol use, or gallbladder disease. It was determined this was an episode of delayed acute pancreatitis due to dapsone. This is a rarely addressed entity in the literature and is the first case in which pancreatitis occurred so late in a patient's treatment course on dapsone.

An unfortunate failure: multifocal hepatocellular carcinoma in a non-cirrhotic patient with chronic hepatitis C treated with ledipasvir/sofosbuvir.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the third highest cause of cancer mortality worldwide. Risk factors include chronic liver disease and cirrhosis of various causes including chronic hepatitis B and C. In cases of chronic hepatitis C virus (HCV), HCC usually does not manifest unless the liver has become cirrhotic. Fortunately, novel treatments for hepatitis C including ledipasvir/sofosbuvir can cure patients from their disease and as a result, may never develop cirrhosis and therefore, be at much lower risk of developing HCC. We present a patient with chronic HCV genotype 1a who was successfully treated with ledipasvir/sofosbuvir with documented sustained viral response, but 6 months later was found to have multifocal HCC with virus reactivation with no evidence of cirrhosis on imaging or biochemical testing. While novel antiviral agents for HCV lead to >90% cure rate, cure is defined as sustained viral response of only 12 weeks. This brings to light a new patient population who may require further follow-up than 3 months to ensure viral clearance. Furthermore, this patient developed HCC despite initial viral clearance and no evidence of cirrhosis, indicating possible oncogenic potential of HCV that is independent of cirrhosis that necessitates further investigation.