PANCREATITIS DURING INTRAVENOUS PENTAMIDINE THERAPY IN AN AIDS PATIENT WITH PRIOR EXPOSURE TO DIDANOSINE

OBJECTIVE: To report a case of an HIV-positive man who received sequen tial didanosine and pentamidine treatment and subsequently developed a cute clinical pancreatitis. CASE SUMMARY: In June 1992 didanosine 200 mg po bid was initiated in a 30-year-old man with AIDS. After a 22-wee k course of didanosine, the patient was hospitalized and didanosine wa s discontinued on day 4. The patient then received 8 days of treatment for a presumed Pneumocystis carinii pneumonia (PCP) with pentamidine 4 mg/kg/d iv. As the patient responded clinically to therapy, he was d ischarged home to complete a 21-day course of pentamidine. On day 14 o f therapy, the patient experienced nausea, vomiting, diarrhea, fatigue , and was hypotensive. The dosage of pentamidine was reduced by 50 per cent. After receiving 18 doses of pentamidine, treatment was discontin ued, as symptoms had worsened and serum amylase and lipase concentrati ons were elevated. The patient was hospitalized and the diagnosis of a cute clinical pancreatitis was made. After a 21-day hospitalization, t he patient was discharged home in fair condition on hyperalimentation. DISCUSSION: Potential causes of pancreatitis, including opportunistic infections, neoplasms, and drugs, are discussed. The most probable fa ctors associated with pancreatitis in our patient are didanosine and p entamidine therapy. CONCLUSIONS: As our patient developed pancreatitis following sequential administration of didanosine and pentamidine, it would be prudent to monitor for signs and symptoms of pancreatitis in similar cases. In addition, didanosine should be discontinued during and for one week following treatment of PCP when pentamidine is used.