Glucocorticoids as a novel approach to the treatment of disabling side effects of sodium stibogluconate.

Abstract

WHAT IS KNOWN AND OBJECTIVE:

Intravenous sodium stibogluconate (SbV) is the mainstay of treatment for mucocutaneous leishmaniasis. Incidence of this disease is increasing in the UK, partly because of returning military personnel. SbV has a side effect profile that requires treatment interruption in up to 28% of patients. Side effects can be unpleasant and - in the case of QTc prolongation - dangerous.

CASE SUMMARY:

A volunteer medical worker returning from Guatemala was diagnosed with mucocutaneous leishmaniasis. Because of previous renal problems, NSAIDs were contraindicated. Severe side effects of myalgia and arthralgia would have necessitated a treatment interruption, but a trial of prednisolone gave excellent symptomatic relief. The patient's QTc, amylase and C-reactive protein also fell following initiation of steroid treatment. The SbV treatment course was completed successfully.

WHAT IS NEW AND CONCLUSION:

This is the first reported case of the dangerous and disabling side effects of SbV being treated very effectively with glucocorticoids. Of note is the normalization of the apparently sodium stibogluconate-induced prolongation of the QTc interval. Further investigation into this potential beneficial effect is warranted.

• Authors: J M Brostoff, D N Lockwood
• Journal: Journal of clinical pharmacy and therapeutics (J Clin Pharm Ther) Vol. 37 Issue 1 Pg. 122-3 (Feb 2012) ISSN: 1365-2710 [Electronic] England
• PMID: 21457289 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2011 Blackwell Publishing Ltd.

Chemical References

• Antiprotozoal Agents
• Glucocorticoids
• Prednisolone
• Antimony Sodium Gluconate

Topics

• Adult
• Antimony Sodium Gluconate (adverse effects, therapeutic use)
• Antiprotozoal Agents (adverse effects, therapeutic use)
• Arthralgia (chemically induced, drug therapy)
• Glucocorticoids (therapeutic use)
• Guatemala
• Humans
• Leishmaniasis, Mucocutaneous (drug therapy)
• Long QT Syndrome (chemically induced, drug therapy)
• Male
• Prednisolone (therapeutic use)