Case Report: Acute biliary pancreatitis after semaglutide dose escalation in an adolescent with obesity and cholelithiasis.

Background: Semaglutide is increasingly used for weight management in adolescents with obesity. Although gastrointestinal adverse effects are common, gallbladder disease and acute pancreatitis are less frequent but clinically important complications. The relationship between semaglutide therapy, biliary disease, and pancreatitis in adolescents remains incompletely characterized. Case description: A 16-year-old female with obesity was treated with glucagon-like peptide-1 receptor agonists for weight management. Following approximately nine months of liraglutide therapy, she was transitioned to semaglutide and subsequently escalated to 2.4 mg once weekly, with substantial weight loss. An abdominal ultrasound performed before escalation to 2.4 mg demonstrated multiple small gallstones without biliary ductal dilatation. Approximately five weeks after dose escalation, she presented with severe epigastric pain, nausea, and vomiting. Laboratory investigations demonstrated elevated lipase, bilirubin, AST, and ALT. Ultrasound and magnetic resonance cholangiopancreatography confirmed multiple gallstones without choledocholithiasis or biliary ductal dilatation. She was diagnosed with acute biliary pancreatitis and managed conservatively. Semaglutide was discontinued, followed by laparoscopic cholecystectomy. Histopathology demonstrated chronic calculous cholecystitis. The Naranjo Adverse Drug Reaction Probability Scale yielded a score of 3, corresponding to a possible adverse drug reaction. Conclusion: This case highlights the clinical complexity of acute biliary pancreatitis occurring during semaglutide therapy in an adolescent with documented cholelithiasis. Although a definitive causal relationship cannot be established, the temporal relationship dose escalation and substantial weight loss raises the possibility that semaglutide may have contributed to the development of biliary complications and subsequent pancreatitis. Clinicians should remain vigilant for gallbladder disease and pancreatitis in adolescents receiving glucagon-like peptide-1 receptor agonists, particularly those with known gallstones or substantial weight loss.