Hepatotoxicity possibly caused by amphotericin B.
OBJECTIVE
To report a case of possible amphotericin B-induced hepatotoxicity in a patient with pulmonary blastomycosis.


CONCLUSIONS
A 26-year-old white man with life-threatening pulmonary blastomycosis developed elevation of his liver enzymes after the addition of amphotericin B to his initial itraconazole therapy. The hepatotoxicity resolved rapidly with discontinuation of the amphotericin B, and the blastomycosis was successfully treated with itraconazole alone.


CONCLUSIONS
This case illustrates an unusual occurrence of hepatotoxicity associated with a short course of amphotericin B. Liver biopsy was compatible with drug-induced changes and showed no evidence of blastomycosis. Discontinuation of amphotericin B with no other therapeutic changes resulted in a rapid resolution of hepatotoxicity. A possible adverse drug interaction with itraconazole and amphotericin B is postulated based on the mechanism of action of each drug.


CONCLUSIONS
Amphotericin B therapy can be associated with many adverse effects, but reports of hepatotoxicity are rare. Closer monitoring of liver enzymes in patients receiving amphotericin B, especially in combination with potentially hepatotoxic agents, including azole antifungal drugs, would be prudent.
Program in Internal Medicine, University of Western Ontario, London, Canada.
J
J
Gill
H R
HR
Sprenger
E D
ED
Ralph
M D
MD
Sharpe
D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001759:Blastomycosis / Q000150:complications / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology / Q000473:pathology*; D004359:Drug Therapy, Combination; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use; D008111:Liver Function Tests; D008297:Male
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B