Pancreatic pathology in pentamidine-induced diabetes in acquired immunodeficiency syndrome patients.

An acquired immunodeficiency syndrome patient who was treated with pentamidine for a pneumocystis infection developed hypoglycemia followed by diabetes mellitus. The pathologic findings in the pancreas consisted of a significant decrease in the number of insulin-positive cells as measured by immunoperoxidase techniques when compared with comparable tissue from an age- and sex-matched control. There was also a decrease in the staining intensity of the insulin-positive cells, an absolute increase in the glucagon-positive cells, and no significant change in the number of somatostatin-positive cells. Routinely stained histologic sections showed morphologic changes in the islets with features different from those described in insulin-dependent diabetes mellitus or those caused by the toxin Vacor. The islets had increased vascular spaces, no islet cell necrosis, no fibrosis, and no lymphocytic infiltrates when compared with an age-matched control.