Foisy M M, Slayter K L, Hewitt R G, Morse G D
Pharmacy Department, Wellesley Hospital, Toronto, Ontario, Canada.
Ann Pharmacother. 1994 Sep;28(9):1025-8. doi: 10.1177/106002809402800905.
To report a case of an HIV-positive man who received sequential didanosine and pentamidine treatment and subsequently developed acute clinical pancreatitis.
In June 1992 didanosine 200 mg po bid was initiated in a 30-year-old man with AIDS. After a 22-week course of didanosine, the patient was hospitalized and didanosine was 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 discharged home to complete a 21-day course of pentamidine. On day 14 of therapy, the patient experienced nausea, vomiting, diarrhea, fatigue, and was hypotensive. The dosage of pentamidine was reduced by 50 percent. After receiving 18 doses of pentamidine, treatment was discontinued, as symptoms had worsened and serum amylase and lipase concentrations were elevated. The patient was hospitalized and the diagnosis of acute clinical pancreatitis was made. After a 21-day hospitalization, the patient was discharged home in fair condition on hyperalimentation.
Potential causes of pancreatitis, including opportunistic infections, neoplasms, and drugs, are discussed. The most probable factors associated with pancreatitis in our patient are didanosine and pentamidine therapy.
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.
报告一例接受去羟肌苷和喷他脒序贯治疗后发生急性临床胰腺炎的HIV阳性男性病例。
1992年6月，一名30岁艾滋病男性开始口服去羟肌苷，200毫克，每日两次。接受22周的去羟肌苷治疗后，患者住院，第4天停用去羟肌苷。随后患者因疑似卡氏肺孢子虫肺炎（PCP）接受了8天的喷他脒治疗，静脉注射剂量为4毫克/千克/天。由于患者临床治疗有反应，出院回家完成21天的喷他脒疗程。治疗第14天，患者出现恶心、呕吐、腹泻、疲劳，且血压降低。喷他脒剂量减少50%。接受18剂喷他脒后，因症状恶化且血清淀粉酶和脂肪酶浓度升高而停止治疗。患者住院，诊断为急性临床胰腺炎。经过21天住院治疗后，患者接受肠外营养，病情尚可时出院回家。
讨论了胰腺炎的潜在病因，包括机会性感染、肿瘤和药物。与我们患者胰腺炎相关的最可能因素是去羟肌苷和喷他脒治疗。
由于我们的患者在先后接受去羟肌苷和喷他脒治疗后发生了胰腺炎，在类似病例中监测胰腺炎的体征和症状是谨慎的做法。此外，在使用喷他脒治疗PCP期间及之后一周应停用去羟肌苷。
