Verified Rigor RecordRigor Reviewed

Rigor-Reviewed Manuscript

Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report · 10.1002/ccr3.8186

Name: Verified Rigor Record — Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report · 10.1002/ccr3.8186
Item: Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report · 10.1002/ccr3.8186
Rating: 80
Author: Αlpha¹

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · July 6, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

WARN

Warnings to address · Case Report

Eight dimensions — click a segment for details

Critical

High-priority

Model-reported confidence: moderateReviewer agreement: moderateEngine: 7.6.0Source: full text

Not verified in this report

No reported statistical tests were found to recompute.
No data or code availability links were detected to verify.

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This case report has a well-established scientific premise and adequate methods for a descriptive case, but has several reporting gaps: missing IRB/ethics statement, no reporting guideline reference, a vague data availability statement, and incomplete demographic reporting (weight, race/ethnicity). The copyedit and integrity checks also identified minor inconsistencies.

Evaluated as a single case report. Three of eight dimensions (study design, key resources, statistical analysis) were rated not applicable. The reviewers agreed on 5 of 8 dimensions; there were minor disagreements on biological variables (R3 voted warn vs R1/R2 pass) and ethical approvals (R2 voted pass vs R1/R3 warn), which were resolved by weighing the specific evidence.

9 major claims checked against the paper's own evidence: 1 not fully backed by the presented evidence (unsupported or overstated).

2 integrity concerns flagged (0 high).

Rigor

Eight Dimensions2 pass · 3 warn

9 major claims1 unsupported3 partial5 supported

The paper cites prior research on drug-induced acute pancreatitis and levofloxacin's adverse effects, providing a logical rationale linking levofloxacin to the observed pancreatitis. Limitations of prior case reports are implicitly addressed through detailed exclusion of other causes. The premise is clearly stated: levofloxacin can induce acute pancreatitis, a rare but important diagnosis.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper cites prior literature on drug-induced acute pancreatitis and levofloxacin-associated cases, establishes a logical rationale for the case, and acknowledges limitations of prior research.

Evidence

direct quote[Introduction, paragraph 1-2; Discussion, paragraph 1-2]

“Levofloxacin belongs to a class of fluoroquinolone antibiotics used for treating intraabdominal infections...Levofloxacin also has a toxic effect on pancreatic tissue inducing acute pancreatitis, which is rarely described in the literature.”

direct quote[Discussion, paragraph 2]

“The incidence of levofloxacin-induced acute pancreatitis is not yet identified as only limited data are available.”

direct quote[Introduction, final sentence]

“We report a case of levofloxacin-induced acute pancreatitis.”

PASSReviewer 2· 95% conf

The scientific premise is well-established with adequate citations and rationale.

Evidence

direct quote[Introduction, paragraph 2]

“Levofloxacin also has a toxic effect on pancreatic tissue inducing acute pancreatitis, which is rarely described in the literature. A few cases have been published on levofloxacin as an etiology of acute pancreatitis.”

direct quote[Introduction, paragraph 1]

“Drug‐induced acute pancreatitis is a potentially ignored diagnosis that must be precisely valued.”

paraphrase[Case Presentation, paragraph 2]

“After ruling out all other possible causes (alcohol, gallstones, hypertriglyceridemia, infection, trauma), a provisional diagnosis of levofloxacin-induced acute pancreatitis was made.”

PASSReviewer 3· 95% conf

The paper establishes a clear scientific premise by citing prior work on drug-induced pancreatitis and levofloxacin as a rare cause, and provides a logical rationale linking the case to the literature.

Evidence

direct quote[Introduction, paragraph 2]

“A few cases have been published on levofloxacin as an etiology of acute pancreatitis.”

direct quote[Introduction, paragraph 2]

“Levofloxacin also has a toxic effect on pancreatic tissue inducing acute pancreatitis, which is rarely described in the literature.”

direct quote[Discussion, paragraph 1]

“The incidence of levofloxacin-induced acute pancreatitis is not yet identified as only limited data are available.”

This is a single-patient case report describing a clinical presentation and management. There is no randomization, blinding, power analysis, replicate distinction, inclusion/exclusion criteria beyond the patient, outlier handling, controls, or independent replication. The design is purely descriptive and does not involve the experimental elements assessed in this dimension, so every sub-criterion is marked not_applicable.

Sub-criteria

controlsN/A

power analysisN/A

blinding levelsN/A

outlier handlingN/A

randomization unitN/A

inclusion exclusionN/A

randomization methodN/A

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 95% conf

As a single case report, there is no experimental design with randomization, blinding, or controls, and all sub-criteria are not applicable.

Evidence

absence[Entire manuscript]

Single case report, no randomization/controls.

N/AReviewer 2· 95% conf

Study design rigor criteria (randomization, blinding, power analysis, etc.) are not applicable to a single case report.

Evidence

paraphrase[Case Presentation]

“A single 44-year-old female patient is described with history, examination, labs, imaging, and outcome. No randomization, blinding, or control group is mentioned.”

absence[Entire paper]

No power analysis, inclusion/exclusion criteria, or outlier handling is mentioned.

N/AReviewer 3· 95% conf

As a single case report, the study design does not involve randomization, blinding, power analysis, or other experimental design elements, making this dimension not applicable.

Evidence

direct quote[Title and Abstract]

“Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report”

The paper reports the patient's sex (female), age (44 years), medical history (hypothyroidism, diabetes, hypertension), and health status on admission. Species/strain/source and housing conditions are not applicable as this is a human case. Demographics (age, sex, comorbidities) are adequately provided. Since both sexes are not involved and the patient is female, sex_justified is not required.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Patient age, sex, health status, and relevant comorbidities are reported; demographics are described; species/strain/housing criteria are not applicable.

Evidence

direct quote[Case Presentation, paragraph 1]

“A 44-year-old female with a past medical history of hypothyroidism and diabetes mellitus presented with abdominal pain and vomiting for the last 3 days.”

direct quote[Case Presentation, paragraph 1]

“She had been taking amlodipine for hypertension and insulin for diabetes...”

absence[Case Presentation]

Race/ethnicity not reported.

PASSReviewer 2· 95% conf

Biological variables are adequately reported for a case report: sex, age, health status, and key demographic details are provided.

Evidence

direct quote[Case Presentation, paragraph 1]

“A 44‐year‐old female”

direct quote[Case Presentation, paragraph 1]

“A 44‐year‐old female with a past medical history of hypothyroidism and diabetes mellitus presented with abdominal pain and vomiting”

direct quote[Case Presentation, paragraph 2]

“She was hemodynamically stable with blood pressure (100/70 mmHg), respiratory rate (21/min), and heart rate (99/min).”

WARNReviewer 3· 85% conf

The paper reports the patient's age, sex, and some health status, but does not report weight, race/ethnicity, or other demographics beyond age and sex.

Evidence

direct quote[Case Presentation, paragraph 1]

“A 44-year-old female with a past medical history of hypothyroidism and diabetes mellitus presented with abdominal pain and vomiting for the last 3 days.”

absence[Case Presentation]

Weight and race/ethnicity are not reported.

The paper includes a consent statement: 'Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.' However, there is no mention of ethics committee (IRB) approval or a protocol number. For a case report, ethics approval is typically required, and its absence is a reporting gap.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementNOT REPORTED

regulatory complianceNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 80% conf

Informed consent is reported as 'written informed consent was obtained', but there is no IRB/ethics committee approval statement for this case report (which involves a human patient).

Evidence

direct quote[CONSENT section]

“Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.”

absence[Entire manuscript]

No IRB/ethics approval statement found.

absence[Entire manuscript]

No regulatory compliance statement (e.g., Declaration of Helsinki).

PASSReviewer 2· 85% conf

Ethical approvals are addressed: written informed consent was obtained from the patient; compliance is stated.

Evidence

direct quote[Consent paragraph]

“Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.”

direct quote[Acknowledgements]

“Signed consent for a case report was obtained from the patient's legally authorized representative (LAR).”

WARNReviewer 3· 90% conf

The paper states that written informed consent was obtained from the patient, but does not mention ethics committee approval or a protocol number, which is a reporting gap for a case report.

Evidence

direct quote[Consent section]

“Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.”

absence[Ethics section]

No ethics committee approval is mentioned.

The paper describes a clinical case with patient history, lab tests, and imaging. No antibodies, cell lines, mycoplasma testing, organisms, or reagents are used. The only 'resources' are standard clinical laboratory tests and imaging; these are not considered key biological/chemical resources as defined. Software is not used beyond standard clinical practice. The investigational product is levofloxacin, but it is not studied in a trial context — it is simply a medication the patient was taking. Therefore, the dimension is not_applicable.

Sub-criteria

mycoplasma testingN/A

reagents identifiedN/A

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedN/A

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 95% conf

This case report involves no biological or chemical resources such as antibodies, cell lines, organisms, reagents, or bespoke software; it is a purely descriptive clinical report.

Evidence

absence[Entire manuscript]

No biological resources are used in this case report.

PASSReviewer 2· 85% conf

Key resources are adequately identified for a case report: relevant laboratory tests and imaging are referenced, but no study-specific reagents, software, or investigational products were used that require detailed identification.

Evidence

direct quote[Case Presentation, paragraph 3]

“Immediately, levofloxacin was discontinued... For a urinary tract infection, she was started on fosfomycin.”

direct quote[Case Presentation, paragraph 3]

“An abdominal ultrasound demonstrated a non‐distended gallbladder... Abdomen CT was performed”

absence[Entire paper]

No study-specific reagents, software, or cell lines were used.

N/AReviewer 3· 95% conf

The paper does not use any key biological or chemical resources (antibodies, cell lines, reagents, software) that require identification, making this dimension not applicable.

Evidence

absence[Entire paper]

No key biological or chemical resources are used.

The paper presents initial and follow-up laboratory parameters in a table (e.g., amylase, lipase) but does not perform any inferential statistical tests, group comparisons, or hypothesis testing. No p-values, effect sizes, or test statistics are reported. The dimension is not applicable because the study is a descriptive case report without inferential statistics.

Sub-criteria

tests namedN/A

exact p valuesN/A

effect sizes ciN/A

data presentationN/A

software identifiedN/A

assumptions verifiedN/A

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 95% conf

No inferential statistical tests are performed; only descriptive laboratory values are presented from a single patient.

Evidence

absence[Entire manuscript]

No inferential statistical tests reported.

N/AReviewer 2· 95% conf

No inferential statistical analyses were performed; this is a descriptive case report.

Evidence

absence[Entire paper]

No statistical tests are mentioned.

direct quote[Table 1]

“Parameter Initial lab value on admission Lab value after drug discontinuation Reference range”

N/AReviewer 3· 95% conf

The paper does not perform any inferential statistical tests; it only reports descriptive laboratory values, making this dimension not applicable.

Evidence

absence[Results and Table 1]

No inferential statistics are used.

The data availability statement says: 'The case report's pertinent data are available from the corresponding author upon reasonable request.' This is a vague statement without a repository, platform, or conditions, making it reported_but_inadequate. No code was used, so code_sharing is not applicable.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementINADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

A data availability statement is present but vague ('data from the corresponding author upon reasonable request' with no platform or timeframe), and no code sharing or repository deposit is applicable.

Evidence

direct quote[DATA AVAILABILITY STATEMENT]

“The case report's pertinent data are available from the corresponding author upon reasonable request.”

WARNReviewer 2· 85% conf

A data availability statement is provided but is vague ('available from corresponding author on reasonable request'); no code was generated.

Evidence

direct quote[Data Availability Statement]

“The case report's pertinent data are available from the corresponding author upon reasonable request.”

absence[Entire paper]

No repository deposit or code sharing is mentioned.

WARNReviewer 3· 90% conf

The paper includes a data availability statement, but it is vague ('available from the corresponding author upon reasonable request') with no repository or platform, which is inadequate.

Evidence

direct quote[Data Availability Statement]

“The case report's pertinent data are available from the corresponding author upon reasonable request.”

Methods are described in sufficient detail for a case report. Limitations are discussed (rarity, delayed diagnosis). A conflict of interest statement is present. However, no reporting guideline (e.g., CARE checklist) is mentioned, and the funding statement is vague ('The authors declare that they have no known competing financial interests...'). The conclusions are proportional to the evidence.

Sub-criteria

funding coiINADEQUATE

trial registrationN/A

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 80% conf

Methods are adequately described for a case report, limitations are discussed, and conclusions are proportional. However, no reporting guideline (CARE) is referenced, and the funding/conflict-of-interest statement is present but ambiguous as it appears twice with contradictory statements.

Evidence

absence[Entire manuscript]

No reporting guideline (e.g., CARE) referenced.

direct quote[FUNDING INFORMATION]

“The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”

direct quote[Conclusions, paragraph 1]

“Levofloxacin or drug-induced pancreatitis is a diagnosis of exclusion...”

PASSReviewer 2· 85% conf

Reporting completeness is adequate for a case report: methods are detailed, limitations are discussed, conclusions are proportional, and funding/COI are declared.

Evidence

direct quote[Case Presentation, paragraph 3]

“Immediately, levofloxacin was discontinued, and she was kept oral‐free and was managed conservatively with bowel rest, intravenous fluids, appropriate analgesia, antiemetic, and proton pump inhibitor.”

direct quote[Discussion, paragraph 3]

“The patient presented with classic symptoms of acute pancreatitis, but due to the rarity of the cause, that is, levofloxacin as a culprit of pancreatitis, the diagnosis was delayed”

direct quote[Funding Information / Conflict of Interest Statement]

“The authors declare that they have no known competing financial interests... The authors declare no competing interests.”

WARNReviewer 3· 85% conf

The paper reports methods and limitations adequately, but lacks a reporting guideline checklist and does not discuss funding or conflicts of interest in a dedicated section (though a conflict statement is present).

Evidence

absence[Methods]

No reporting guideline is mentioned.

direct quote[Funding Information]

“The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”

9 copyedit issues flagged: mostly consistency, clarity, punctuation.

Checked 14 references: 13 verified — 1 unresolved.

Αlpha¹ Rigor Action ItemsFinal pass before journal submission

This published case report has adequate clinical value but contains several reporting gaps that an informed reader should weigh: the absence of an IRB/ethics approval statement, no reference to the CARE reporting guideline, a vague data availability statement, and an internal contradiction in the consent statement. These gaps do not invalidate the clinical observation but would warrant a correction or erratum to strengthen transparency.

1.
HIGHethics
Add an IRB/ethics committee approval statement (or waiver/exemption rationale) in a dedicated 'Ethics Approval' section; state whether approval was obtained or why it was not required.
This is a human case report and an ethics statement is expected by most journals; its absence is a major reporting gap.
2.
HIGHreporting
Move the conflict of interest statement out of the 'FUNDING INFORMATION' section into the 'CONFLICT OF INTEREST' section, and add a clear funding declaration (e.g., 'No funding was received for this work').
The current FUNDING INFORMATION section incorrectly contains a competing interests statement, which is misleading; a clear funding source (or lack thereof) must be stated.
3.
HIGHreporting
Add a reference to the CARE (CAse REport) guideline and state adherence in the Methods or a dedicated section; optionally provide the checklist as supplementary material.
Reporting guidelines are standard for case reports and improve completeness and transparency.
4.
HIGHethics
Add a statement confirming that the study was conducted in accordance with the Declaration of Helsinki or other relevant ethical guidelines.
Regulatory compliance is a standard expectation in human research reporting.
5.
HIGHdata code
Replace the vague data availability statement with a specific repository (e.g., Zenodo, Figshare) or a managed-access platform with conditions; state that de-identified clinical data are available on reasonable request with a clear contact.
A bare 'available on reasonable request' is insufficient for reproducibility and journal standards.
6.
HIGHreporting
Resolve the internal contradiction in the consent section: clarify whether written informed consent was obtained from the patient or from the legally authorized representative (LAR), or explain why both were obtained.
The current text states both 'written informed consent was obtained from the patient' and 'signed consent was obtained from the patient's LAR', which is confusing and inconsistent.
7.
HIGHrigor
Add a citation or evidence for the claim that 'drug-induced acute pancreatitis is the third common cause of acute pancreatitis after ruling out alcohol and gallstones', or remove the claim if unsupported.
The claim audit flagged this as an unsupported statement; a cited source is needed to substantiate the ranking.
8.
MEDIUMreporting
Report the patient's weight in the case presentation; consider reporting body mass index.
Weight/obesity is a risk factor for pancreatitis and is important for clinical context; its omission is a demographic gap.
9.
MEDIUMreporting
Report the patient's race/ethnicity in the case presentation if available.
Demographic completeness improves generalizability assessment and is a standard element in case reports.
10.
MEDIUMrigor
Include a Naranjo or WHO-UMC causality assessment scale score to strengthen the causal attribution of levofloxacin to pancreatitis.
A structured causality assessment is a standard addition for drug-induced case reports and would strengthen the clinical inference.
11.
LOWreporting
Discuss the patient's hypothyroidism and diabetes control status to address potential confounders for pancreatitis.
Although ruled out as primary causes, describing their control would strengthen the exclusion of alternative causes.
12.
LOWreporting
Verify and correct the reference titled 'Drug‐induced acute pancreatitis: a review' which was not found in the registry; provide a correct citation or remove it if it cannot be verified.
An unresolved reference is a fabrication signal; it must be verified or corrected to maintain research integrity.
13.
LOWcopyedit
Clarify the author contribution 'Software' by Aarfa Devani; specify the role (e.g., data management software) or change to 'Formal analysis' or 'Data curation'.
For a case report, 'Software' is an atypical contribution and may be misinterpreted.
14.
LOWcopyedit
Fix punctuation: add a colon after 'Key Clinical Message' in the Abstract for consistency.
Missing punctuation impairs readability.
15.
LOWcopyedit
Correct the word 'valued' to 'evaluated' or 'considered' in the Abstract and Introduction.
The current phrasing 'must be precisely valued' is not idiomatic.
16.
LOWcopyedit
Reformat the author list with consistent initials and commas to avoid the current run-on string.
Proper formatting is required for indexing and citation.

Full text (15,957 chars)Analyzed: Jul 6, 2026

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