Marques Sílvio Alencar, Merlotto Maira Renata, Ramos Paulo Müller, Marques Mariangela Esther Alencar
Department of Dermatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil.
Department of Pathology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil.
An Bras Dermatol. 2019 Jul 29;94(3):355-357. doi: 10.1590/abd1806-4841.20198388.
Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.
五价锑化合物是治疗美洲皮肤利什曼病的一线药物。我们报告了一名接受血液透析的慢性肾衰竭患者，该患者出现皮肤利什曼病损伤已达四个月。患者在严格的肾脏病学监测下接受了静脉注射葡甲胺治疗，但迅速出现了心脏毒性、急性胰腺炎、全血细胞减少和心源性休克。如本病例所示，葡甲胺锑酸盐的肾脏清除不足可导致严重毒性。这些副作用与药物的累积血浆水平有关。因此，对于透析患者，两性霉素B等二线药物是更好的选择。
