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Paromomycin-associated pancreatitis in HIV-related cryptosporidiosis
W W Tan1, E K Chapnick, E I Abter
1Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219.
Objective:
To report a case of pancreatitis related to paromomycin administration.
Case Summary:
A 39-year-old man with AIDS developed pancreatitis concurrent with successful treatment of intestinal cryptosporidiosis with paromomycin. The hyperamylasemia resolved with discontinuation of the agent and recurred when paromomycin treatment was reinstituted.
Discussion:
To our knowledge, this is the first reported case of pancreatitis believed to be induced by paromomycin. Although pancreatitis in HIV-infected patients has multiple causes, the nature of this case suggests the involvement of paromomycin. The mechanism of action is unclear.
Conclusions:
Pancreatitis should be considered in the differential diagnosis of abdominal pain in patients who are treated with paromomycin.
Insights
This case report details a patient with AIDS who developed pancreatitis during paromomycin treatment for cryptosporidiosis. The pancreatitis resolved upon drug cessation and reappeared with re-administration, suggesting paromomycin as the cause.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Intestinal cryptosporidiosis is an opportunistic infection common in patients with advanced HIV/AIDS.
- Paromomycin is an aminoglycoside antibiotic used to treat certain intestinal protozoal infections.
- Pancreatitis is a known complication in HIV-infected individuals, with various potential etiologies.
Observation:
- A 39-year-old male patient with AIDS presented with pancreatitis during treatment for intestinal cryptosporidiosis.
- The patient was receiving paromomycin for his cryptosporidiosis.
- Hyperamylasemia, a marker for pancreatitis, resolved upon discontinuation of paromomycin and recurred upon its reintroduction.
Findings:
- This case suggests a potential causal link between paromomycin administration and the development of pancreatitis.
- The temporal relationship between paromomycin exposure and pancreatitis, along with recurrence upon re-challenge, supports this association.
- The exact mechanism by which paromomycin may induce pancreatitis remains to be elucidated.
Implications:
- Clinicians should consider paromomycin-induced pancreatitis in the differential diagnosis of abdominal pain in patients receiving this medication.
- This finding may necessitate closer monitoring for pancreatic enzyme elevations in patients treated with paromomycin, particularly those who are immunocompromised.
- Further research into the potential pancreatic toxicity of paromomycin is warranted.