PANCREATITIS INDUCED BY PENTAVALENT ANTIMONIAL AGENTS DURING TREATMENT OF LEISHMANIASIS

Pentavalent antimony (Sb-v). formulated as sodium stibogluconate or me glumine antimoniate, is the standard treatment for the leishmaniases. In 16 of 17 consecutive, prospectively observed patients in Washington D.C., serum levels of amylase and lipase rose to abnormal values afte r therapy with sodium stibogluconate was started; 12 of 17 had symptom s of pancreatitis. Sb-v therapy was continued to completion in 7 of 17 patients and interrupted in 10 of 17. Pancreatitis improved in every patient after Sb-v therapy was stopped. Sb-v treatment was resumed aft er brief interruptions in 6 of 10 patients. All six of these patients had flares of pancreatitis, but each completed therapy. Subsequently, we measured amylase and lipase levels in stored sera from 32 patients treated in Peru with either sodium stibogluconlate or meglumine antimo niate for mucosal leishmaniasis. In all 32 Peruvian patients, serum am ylase and lipase rose to abnormal levels during Sb-v therapy; 11 of 32 had symptoms of pancreatitis. Standard Sb-v regimens induce pancreati tis in almost all patients, but continued therapy is often tolerated; pancreatitis subsides when therapy is stopped, and rechallenge may be tolerated after a brief halt in treatment.