A 49-year-old man, who had a 30-year history of drinking the equivalent of 80 g of
ethanol per day, underwent a detailed medical examination for
cough and
dyspnea. Chest-abdominal computed tomography and endoscopic retrograde pancreatography led to the diagnosis of a mediastinal
pancreatic pseudocyst resulting from obstruction of the pancreatic duct by a
protein plug. The pseudocyst rapidly improved with
conservative treatment with
camostat mesilate, H2-receptor antagonist and digestive
enzymes. Although the patient abstained from alcohol for approximately 6 months, he resumed drinking, leading to recurrent attacks of
pancreatitis.
Bromhexine hydrochloride was then administered for 6 months, with the expectation that it would have a
mucolytic effect on the pancreatic juice, resulting in improvement in the clinical symptoms, pancreatic
enzymes and pancreatic exocrine function, as well as elimination of the
protein plug.
Bromhexine hydrochloride may be a new
therapy for pathological states, such as alcoholic
chronic pancreatitis, in which there is increased viscosity of the pancreatic juice because of elevated
protein concentration, leading to
protein plug formation and temporary blockage of the pancreatic duct.