Pancreatitis Associated with N-Methyl-Glucamine Therapy in a Dog with Leishmaniasis

N-methyl-glucamine is the treatment of choice for leishmaniasis in dogs. Acute pancreatitis is recognized as a common complication of antimonial therapy in human patients. However, acute pancreatitis during the antimonial therapy of canine lieshmaniasis has not been documented in veterinary medicine. Measurement of serum cPLI concentrations is currently the most sensitive and specific test available for the diagnosis of canine pancreatitis. The present report describes a case of acute pancreatitis during meglumine therapy in a dog affected by visceral leishmaniasis.A 12-year-old, intact male, English Setter dog with leishmaniasis was referred to the Veterinary Teaching Hospital of University of Teramo. A diagnosis of leishmaniasis had been made more than 4 years previously and treated with N-methyl glucamine on two occasions. The dogs was polyuric and polydipsic and physical examination revealed enlargement of right lynphonode and muco-purulent discharge. Haematological abnormalities include mild normocytic-normochromic anemia, hypoalbuminemia, increased globulin, mild proteinuria (UPC ratio = 1.4). A relapsed of leishmaniasis was confirmed by serological testing (IFA 1:180) and by demostration of amastigotes in lymph node aspirates. Therapy with n-methyl-glucamine (50 mg/Kg SQ BID, allopurinol 15 mg/Kg PO SID, ramipril at 0,125 mg/Kg PO SID was instituted. On the 10th day after initiation of treatment, the dog developed anorexia, depression and pale mucous membranes. The clinical condition progressively worsened up until the 21th day of therapy, when vomiting, tremors and oedema of the head and limbs, and leukocytosis were observed. Abdominal ultrasonographic evaluation revealed abnormalities consistent with pancreatitis. The serum cPLI concentration was marked increased (2401 mcg/L, cut-off value for pancreatitis was >200 mcg/L). N-methyl-glucamine therapy was discontinued and the supportive care for pancreatitis was instituted. The clinical condition of the dog progressively improbe over the next 10 days. Serum saples were collected every 2 days from the beginning of the antimonial therapy up to 3 days after complete resolution of clinical signs of apancreatitis. The cPLI increased over the cut-off value starting from 5 th day of therapy, and maintained high values up to 2 days after cessation of therapy.Pancreatitis has been reported in two dogs with leishmaniasis, but diagnosis was made based on non-specific clinical signs and unreliable biochemical test. However acute hemorragic pancreatitis was confirmed on post mortem examination of a dog with leishmaniasis. In Veterinary Medicine, vomiting, abdominal pain, and anorexia have been recognized anedoctically as adverse effects of antimonials in dogs. In our dog the timing between “abdominal symptoms”, an increased in serum cPLI concentrations, abdominal ultrasonographic findings, and N-methyl-glucamine administration make antimonials the most probable cause of pancreatitis.Moreover pancreatitis subsided when antimonial therapy was discontinued. In the present case, clinical signs gradually worsened from 10 to 21 after the beginning of antimonial therapy. An increased in the serum concentration of cPLI was evident from the 5th day of therapy, reaching the highest value around day 10 and staying elevated until a few days after cessaton of antimanial therapy. To the best of our knowlodge, this clinical case represents the first report of a case of pancreatitis associated with N-methyl-glucamine therapy. The authors believe that antimonial derivates should be included in the list of drugs that may induce pancreatitis in dog. However the specific role of th N-methyl-glucamine in the induction of pancreatitis in dogs needs further study.[...]