Pentamidine-associated fatal acute pancreatitis

Area of Science:

• Infectious Diseases
• Gastroenterology
• Pharmacology

Background:

• Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS).
• Pentamidine isethionate is a standard treatment for PCP, but it has known toxicities, including effects on pancreatic islet cells.
• While pentamidine can induce glycemic disturbances, symptomatic pancreatitis is an infrequent adverse event.

Observation:

• A case of severe hemorrhagic pancreatitis occurred in an AIDS patient undergoing treatment with pentamidine isethionate for PCP.
• The patient's condition rapidly deteriorated due to pancreatitis complications.
• Despite immediate discontinuation of pentamidine, the patient succumbed to the illness.

Findings:

• Pentamidine isethionate can induce severe hemorrhagic pancreatitis, a rare but potentially fatal adverse effect.
• This case represents the second reported instance of fatal pancreatitis linked to pentamidine therapy in medical literature.
• The known pancreatic islet cell toxicity of pentamidine may contribute to the development of pancreatitis.

Implications:

• Clinicians should maintain a high index of suspicion for pancreatitis in AIDS patients treated with pentamidine, especially those with risk factors.
• Early recognition and prompt drug withdrawal are crucial, though not always sufficient to prevent fatal outcomes.
• Further research may be warranted to elucidate the precise mechanisms underlying pentamidine-induced pancreatitis and identify predictive factors.