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CASO CLINICO N° 01 NOMBRE: C.V.J.R EDAD: 43 años SEXO: Masculino PESO: 85 Kg HISTORIA CLINICA: 235600 ESTABLECIMIENTO DE SALUD: Hospital Militar Central DESCRIPCION DEL CASO Paciente con diagnóstico de Leishmaniasis cutánea inicia tratamiento con Estibogluconato de sodio (1.5 g) EV diario desde el 19 de Junio del 2008. El 26 de Junio del 2008 presenta mialgias en miembros inferiores, artralgias, fatiga, cefalea luego de recibir 8 dosis de Estibogluconato de sodio (1.5 g) EV, completó las 13 dosis, se recupera y acude al HMC. Antecedentes patológicos: No presenta Diabetes Mellitus tipo 2, ni hipertensión arterial ni tuberculosis. En el 2007 se le diagnosticó hipercolesterolemia y en 1994 gastritis, niega haber presentado reacciones adversas a medicamentos anteriormente. Consume alcohol ocasionalmente. Al ingreso presentó Aparente regular estado general, estado de nutrición y estado de hidratación.. Funciones Vitales: F.C: 70 F.R: 20 PA: 100/60 T°: 37 Recibe como terapia de soporte Ibuprofeno tab, diclofenaco 75 mg inyectable. Reinicia tratamiento con Estibogluconato de sodio el 17 de julio del 2008 presentándose nuevamente el malestar antes descrito. NOTIFICA: NOMBRE: LAC PROFESION: QUIMICO FARMACEUTICO DIRECCION: HOSPITAL MILITAR CENTRAL FECHA: 10-01-2009 Micromedex 2.0 SODIUM STIBOGLUCONATE A) MECHANISM OF ACTION 1) Sodium stibogluconate (sodium antimony gluconate) is one of 2 pentavalent antimony compounds used in the treatment of leishmaniasis (Balloud et al, 1987); the other compound is meglumine antimoniate. 2) Chemically, sodium stibogluconate is of indefinite composition; it contains 30% to 34% antimony when dried. 3) Pentavalent antimonial compounds have been used for decades in the treatment of visceral, cutaneous, and mucocutaneous leishmaniasis. However, the precise mechanism of action of the antimonials remains unknown. These compounds may inhibit various enzymes in Leishmania and possibly have actions on parasite ribosomes. 4) Electron microscopy studies of Leishmania donovani in splenic aspirates of patients with visceral leishmaniasis have suggested that sodium stibogluconate affects active transport functions and/or the permeability of parasite membranes. B) REVIEW ARTICLES 1) The treatment of leishmaniasis is reviewed, including use of pentavalent antimonials, amphotericin B, paromomycin (aminosidine), pentamidine, and imidazole compounds. Cutaneous leishmaniasis a) A 10-day course (n=19) of sodium stibogluconate 20 milligram/kilogram/day was as effective as a 20-day course (same dosage) (n=19) in the treatment of cutaneous leishmaniasis in US military personnel (age range: 19-44 years) in a well-designed study b) Kenyan cutaneous leishmaniasis (LEISHMANIA AETHIOPICA) has been more resistant and higher doses appear to be needed. Intravenous sodium stibogluconate in doses of 18 to 20 milligrams of antimony/kilogram twice daily for 30 days have been effective . c) A 28-day or 40-day course of sodium stibogluconate (equivalent to 20 milligrams of antimony 1 kilogram/day) achieves approximately a 63% cure rate . The generally accepted treatment duration for cutaneous leishmaniasis is 20 days . d) Combination sodium stibogluconate and aminosidine appear to prevent relapses for up to 21 months. They also stated that the use of antimony compounds by themselves resulted in relapses. e) Higher doses may be required for patients with Leishmania tropica or Leishmania major and/or extension of therapy to at least 30 days, with repeat courses being administered if necessary. Doses of 20 milligrams/kilogram twice daily (every 12 hours) or prolongation of therapy to 60 days with doses of 20 milligrams/kilogram daily have been suggested in relapsed patients. f) Recommended intravenous or intramuscular doses of sodium stibogluconate in patients with American cutaneous leishmaniasis due to LEISHMANIA BRAZILIENSIS or LEISHMANIA MEXICANA are 20 milligrams of antimony/kilogram/day (max 850 milligrams) once daily for 20 to 28 days, repeated or continued until clinical response is evident. Musculoskeletal Effects Arthralgia 1) Arthralgia and MYALGIA have been described with stibogluconate patients . Although arthralgia was reported in only 5 of 371 patients receiving 15 or 20 mg/kg/day intramuscularly for the treatment of visceral leishmaniasis in one study, this complication appears to be relatively frequent (58% to 83%) in other reports . Anti-inflammatory agents were effective in reducing arthralgic pain . 2) Arthralgias (58% to 60% incidence) and myalgias (50% to 55% incidence) were the most frequently reported adverse reactions in a non- controlled U.S. military study (n=96) of sodium stibogluconate therapy of leishmaniasis. These symptoms were managed with exercise restrictions and nonsteroidal anti-inflammatory agents. Only 3 cases were severe enough to necessitate interruption of treatment . Neurologic Effects Central nervous system finding 1) HEADACHE, LETHARGY, MALAISE, and NEURALGIAS have been reported in patients treated with parenteral sodium stibogluconate . 2) A reversible PERIPHERAL NEUROPATHY has been associated with SODIUM STIBOGLUCONATE therapy in one patient being treated for cutaneous leishmaniasis. Following 15 days of therapy with daily intravenous sodium stibogluconate (20 milligrams/kilogram; 1,320 mg), numbness and tingling in the extremities, lips, and tongue, were noted. Vibratory sensation was up to 30% decreased in the ankles and fingertips, and the drug was discontinued. At a 10 week follow up visit, the majority of symptoms had resolved