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: 75
Author: Αlpha¹

Paper source

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: highReviewer agreement: moderateEngine: 7.5.0Source: 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.

The paper is a clear case report with an adequately established scientific premise. The main methodological weaknesses are reporting gaps: no ethics committee approval statement, a vague data availability statement, and several transparency issues including a missing reporting guideline, no dedicated limitations section, and an inconsistent funding declaration.

Evaluated as a case report; four dimensions (study design, biological variables, key resources, statistical analysis) were scored as not applicable because their criteria are designed for interventional or experimental studies. The three independent reviewers largely converged, with minor divergence on biological variables (not applicable vs. pass) and ethical approvals (pass vs. warn), resolved by weighing the sub-criteria applicability and the expected standards for human-subject case reports.

6 major claims checked against the paper's own evidence: all adequately supported.

4 integrity concerns flagged (0 high).

Rigor

Eight Dimensions1 pass · 3 warn

6 major claims2 partial4 supported

The introduction cites prior literature on levofloxacin and drug-induced pancreatitis (references 1-14), provides a logical rationale linking the drug to the observed pancreatitis, and describes gaps in knowledge (few reported cases). The discussion and limitations section are present, though limitations are implied rather than explicitly enumerated.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedINADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes its scientific premise by citing prior literature on drug-induced acute pancreatitis and levofloxacin, and provides a clear rationale for the case report.

Evidence

direct quote[Introduction, paragraph 2-3; Discussion, paragraph 1-2]

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

direct quote[Introduction, final sentence]

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

direct quote[Discussion, paragraph 1]

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

PASSReviewer 2· 85% conf

The paper establishes a reasonable scientific premise by citing prior literature on drug-induced pancreatitis and levofloxacin's rare association, and logically links the case to the hypothesis.

Evidence

direct quote[Introduction, Discussion]

“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[Case Presentation]

“Based on clinical, serological, and imaging modalities, a provisional diagnosis of acute pancreatitis induced by levofloxacin was made after ruling out all other possible causes.”

direct quote[Discussion]

“Levofloxacin as an etiology of acute pancreatitis is uncommon, and the number of cases reported is few in numbers. The incidence of levofloxacin-induced acute pancreatitis is not yet identified as only limited data are available.”

PASSReviewer 3· 95% conf

The paper adequately establishes the scientific premise for the case report.

Evidence

direct quote[Introduction, paragraphs 2-3; References]

direct quote[Discussion, paragraph 1]

“The diagnosis was delayed, although levofloxacin was stopped immediately, and the patient was appropriately managed, which alleviated the patient's condition.”

direct quote[Discussion, paragraph 2]

“The mechanism of drug-induced pancreatitis is the involvement of a toxic metabolite or a drug that either directly affects the biochemistry of the pancreatic cells or triggers an immune response against normal pancreatic tissue that further damages the structure and integrity of pancreatic tissues.”

As a case report, the paper does not have a study design that requires randomization, blinding, power analysis, inclusion/exclusion criteria, controls, or replication. The description is a narrative of a single patient case.

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· 100% conf

The paper is a single case report, which does not involve formal study design elements like randomization, blinding, controls, or replication. All sub-criteria are not applicable.

Evidence

direct quote[Case Presentation]

“This is a 44-year-old female...”

N/AReviewer 2· 95% conf

As a single case report, the study design does not involve randomization, blinding, power analysis, biological replicates, pre-specified inclusion/exclusion criteria (beyond clinical diagnosis), controls, or independent replication; the case presentation is descriptive.

Evidence

direct quote[Title, Abstract, Case Presentation]

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

N/AReviewer 3· 95% conf

Study design rigor criteria are not applicable to a single-patient case report.

Evidence

paraphrase[Title and Case Presentation]

“The paper is a case report of a single patient.”

Sex (female), age (44), and health status (hypothyroidism, diabetes, hypertension) are reported. For a single human case, species/strain/source and housing conditions are not applicable. Demographics (race/ethnicity) are not reported, but the dimension is scored not_applicable because most sub-criteria do not apply to a single-patient clinical presentation.

Sub-criteria

demographicsNOT REPORTED

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

Biological variables relevant to a human case report (sex, age, health status, demographics) are adequately reported.

Evidence

direct quote[Case Presentation, first sentence]

“A 44-year-old female with a past medical history of hypothyroidism and diabetes mellitus...”

N/AReviewer 2· 90% conf

The paper involves one human subject; biological variables (sex, age, health status) are reported as part of the case description, but the criteria for this dimension (sex justification, species/strain, housing conditions) are not applicable to a human case report.

Evidence

direct quote[Case Presentation]

“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]

Demographics beyond age and sex are not reported

N/AReviewer 3· 90% conf

Biological variables criteria are not applicable to a human case report.

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 for the last 3 days.”

The paper states written informed consent was obtained from the patient (Consent section). However, for a case report involving a human subject with non-public clinical data, an IRB or ethics committee exemption/approval is generally expected (or a statement that IRB approval was not required). The paper does not mention any IRB or ethics body. Regulatory compliance (Declaration of Helsinki) is not mentioned. The iacuc_statement is not applicable.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementNOT REPORTED

regulatory complianceNOT REPORTED

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval is not applicable as single case reports typically do not require IRB approval if consent is obtained, and consent was obtained as per the journal policy.

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.”

WARNReviewer 2· 85% conf

Informed consent from the patient is stated, but no IRB or ethics committee approval is reported for this single case report involving a human subject and identifiable clinical data.

Evidence

direct quote[Consent]

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

absence[Consent, Acknowledgements]

IRB/ethics approval is not reported

absence[Full paper]

Regulatory compliance is not mentioned

WARNReviewer 3· 85% conf

The paper mentions patient consent but lacks a named ethics board approval statement.

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/Consent sections]

No ethics committee approval or waiver is mentioned.

absence[All sections]

Regulatory compliance statement is absent.

The paper describes a patient case and does not use any experimental resources. No reagents, software, or biological materials are identified that would constitute key resources.

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· 100% conf

No key biological or chemical resources were used in this case report. The study is purely clinical and does not involve antibodies, cell lines, organisms, or custom software.

Evidence

absence[Entire manuscript]

No antibodies, cell lines, organisms, reagents, or software are used.

N/AReviewer 2· 95% conf

The study does not use any key biological or chemical resources, investigational products (the drug levofloxacin is the suspect agent, not a resource to be authenticated), or bespoke software; the case is a clinical description.

Evidence

absence[Full paper]

No key resources are identified in the paper

N/AReviewer 3· 90% conf

The study uses no key biological/chemical resources or investigational products beyond standard clinical care.

Evidence

paraphrase[Entire paper]

“The case report describes standard clinical management and did not involve any wet-lab reagents, cell lines, or dedicated analysis software.”

The paper presents laboratory results (e.g., amylase, lipase) before and after treatment, but does not perform any statistical tests. Therefore, sub-criteria on statistical analysis are not applicable.

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· 100% conf

No inferential statistical tests are performed in this case report. The paper only reports descriptive laboratory values.

Evidence

absence[Results/Table 1]

No statistical tests reported.

N/AReviewer 2· 95% conf

The paper reports only descriptive laboratory values for a single patient over time, with no inferential statistical tests or group comparisons.

Evidence

absence[Case Presentation, Table 1]

No inferential statistics are used

N/AReviewer 3· 95% conf

No inferential statistical analysis is performed.

Evidence

paraphrase[Results and Discussion]

“The paper reports laboratory values in a table and describes trends, but does not perform any inferential statistical tests.”

The data availability statement says 'The case report's pertinent data are available from the corresponding author upon reasonable request.' This is vague and lacks a concrete access route, making it inadequate. No code was used, and no repository deposit or accession numbers are applicable as no raw datasets were generated.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementINADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 90% conf

A data availability statement is present but inadequate, as it only states data are available on reasonable request without specifying a mechanism or repository.

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 present but vague ('available upon reasonable request' without a mechanism or platform), and no code is shared (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.”

WARNReviewer 3· 90% conf

A data availability statement is present but vague ('on reasonable request'), and no code is shared.

Evidence

direct quote[Data Availability Statement]

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

The paper does not mention ARRIVE/CARE guidelines, there is no dedicated limitations section (though some limitations are implied), and the conclusions are proportional. Funding and COI are declared. Methods are detailed but not sufficient for replication in a different setting (no protocol). The paper is a case report, so trial registration is not applicable.

Sub-criteria

funding coiADEQUATE

trial registrationN/A

reporting guidelineNOT REPORTED

methods completenessINADEQUATE

all outcomes reportedADEQUATE

limitations discussedINADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The case report is reported transparently with adequate methods, discussion of limitations, and proportional conclusions.

Evidence

direct quote[Discussion, final paragraph]

“The diagnosis was delayed, although levofloxacin was stopped immediately...”

direct quote[Funding Information and Conflict of Interest Statement]

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

WARNReviewer 2· 80% conf

The paper is generally transparent for a case report but has several gaps: no reporting guideline referenced, no trial registration (not applicable), and the funding/COI statement is inconsistent (conflict of interest section states no competing interests, but funding section also declares no known financial interests, and author contributions list a 'Funding acquisition' author but no funding source is otherwise mentioned).

Evidence

absence[Full paper]

No reporting guideline is referenced

direct quote[Author Contributions, Funding Information]

“Chengala Ananyaa Gowthavaram: Funding acquisition. ... 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]

“Levofloxacin or drug-induced pancreatitis is a diagnosis of exclusion and is generally reached after taking a detailed patient history and performing a physical examination to rule out other important causes of pancreatitis.”

WARNReviewer 3· 85% conf

Reporting is incomplete for several transparency criteria, including lack of a reporting guideline, no limitations section, and proportional conclusion is acceptable.

Evidence

absence[Methods/All sections]

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

absence[All sections]

No dedicated limitations section.

direct quote[Conclusions]

“Drug-induced pancreatitis is a diagnosis of exclusion and is generally reached after taking a detailed patient history and performing a physical examination to rule out other important causes of pancreatitis.”

direct quote[Funding Information and Conflict of Interest Statement]

“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.”

10 copyedit issues flagged: mostly consistency, clarity, other.

Checked 14 references: 13 verified — 1 unresolved.

Αlpha¹ Rigor Action ItemsFinal pass before journal submission

The published work is a descriptive case report; the core clinical narrative is likely sound, but an informed reader should weigh the absence of an IRB/ethics statement, the lack of a dedicated limitations section, the vague data availability statement, and the internal contradiction in the funding declaration as limiting the confidence in full reporting transparency. These gaps support considering an erratum to clarify the ethics approval status and funding source.

1.
HIGHethics
Add an IRB/ethics committee approval statement or a waiver/exemption justification to the Ethics/Consent section; note that many journals require this even for case reports involving a single living patient.
The paper reports non-public identifiable clinical data from a human subject; the complete absence of any ethics review statement is a major reporting gap that could trigger editorial rejection or a reader concern in the published version.
2.
HIGHreporting
Resolve the funding inconsistency: clarify whether specific funding was received (and if so, from which source) or state explicitly that no funding was received; if no funding was received, remove the 'Funding acquisition' role from Author Contributions.
A 'Funding acquisition' author credit implies funding was obtained, but the Funding Information section contradicts this by stating no financial interests; this internal contradiction undermines trust in the reporting.
3.
HIGHreporting
Reference the CARE (CAse REport) checklist in the Methods or as a separate section to improve reporting completeness.
The paper does not mention any reporting guideline; for case reports, the CARE guideline is the standard and its use is expected by many journals to ensure comprehensive reporting.
4.
HIGHdata code
Improve the data availability statement to be more concrete: e.g., provide a link to a de-identified data summary in a repository, or state the institutional data access policy with a point of contact.
The current 'available upon reasonable request' statement is vague and does not meet the growing expectation for actionable data availability.
5.
HIGHreporting
Add a dedicated 'Limitations' section to the Discussion that explicitly enumerates the inherent limitations of a single-case design (e.g., inability to infer causality definitively, recall bias, lack of generalizability).
Limitations are currently implied but not explicitly enumerated; a dedicated section helps readers evaluate the evidence appropriately.
6.
HIGHother
Verify and correct the reference 'Drug-induced acute pancreatitis: a review' (flagged as not found in registry) — ensure the citation is accurate and retrievable, or replace it with a verifiable source.
One of 14 checked references could not be located in any registry, which raises a possible fabrication signal and needs to be resolved before publication or in a correction.
7.
MEDIUMcopyedit
In Table 1, consistently format reference ranges with parentheses for all parameters (e.g., AST reference range should be '(10–40 IU/L)').
The table has mixed formatting (AST without parentheses, others with) which is a minor inconsistency that may distract readers.
8.
MEDIUMcopyedit
In the Case Presentation, rephrase the sentence about medications for clarity: 'She was compliant with her medications, which included amlodipine for hypertension and insulin for diabetes.'
The original phrasing is slightly ambiguous about which medications she was compliant with.
9.
MEDIUMcopyedit
In Table 1, verify and correct the units for alkaline phosphatase: if measured in U/L (as clinically standard), change from 'mg/dL' to 'U/L'.
The units appear inconsistent with clinical practice and may be a data error; can cause misinterpretation.
10.
MEDIUMreporting
Add a regulatory compliance statement (e.g., 'This case report was conducted in accordance with the Declaration of Helsinki') to the Ethical/Consent section.
Regulatory compliance is not mentioned; many journals expect this statement for human-subject research.
11.
LOWcopyedit
In the Abstract, add a colon or period after 'Key Clinical Message' to separate it from the following text.
The heading merges into the sentence, causing a minor readability issue.
12.
LOWcopyedit
In the Figure 1 caption, correct 'Abdomen computed tomography' to 'Abdominal computed tomography' and 'pancreatic diffuse enlargement' to 'diffuse pancreatic enlargement'.
Minor wording issues that affect clarity.
13.
LOWreporting
Consider briefly mentioning the C-reactive protein and erythrocyte sedimentation rate values in the case narrative since they are listed in Table 1.
Values appear in the table but are not referenced in the text, causing a minor inconsistency.

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

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