Amphotericin B--not so terrible.
OBJECTIVE
To describe a patient who developed adverse reactions to two different lipid formulations of amphotericin B: liposomal amphotericin B (AmBisome) and amphotericin B colloidal dispersion (ABCD, Amphocil), yet tolerated amphotericin B deoxycholate (Fungizone) despite renal toxicity.


METHODS
A 72-year-old woman with acute myelomonocytic leukemia was treated with amphotericin B deoxycholate for suspected pulmonary aspergillosis; the drug was well tolerated but resulted in renal failure. Antifungal therapy was then changed to liposomal amphotericin B. Within 10 minutes of liposomal amphotericin B infusion, the patient developed severe dyspnea, chest pain, and a feeling of imminent death. On the following day, liposomal amphotericin B was switched to amphotericin B colloidal dispersion. Again, within 10 minutes of this infusion, the patient developed fever, chills, hypotension, severe chest pain, dsypnea, and a feeling of imminent death. The patient refused any further treatment with these drugs and insisted on switching back to amphotericin B deoxycholate, which was then administered for 10 days and was well tolerated.


CONCLUSIONS
Severe adverse reactions, such as anaphylaxis, cardiac toxicity, and respiratory failure, following administration of all three lipid formulations of amphotericin B have been reported. In most reported cases, switching to a different lipid formulation of amphotericin B was well tolerated. This is in contrast to our case, where a severe reaction was repeated when another lipid preparation was given, necessitating switching back to amphotericin B deoxycholate despite its nephrotoxicity.


CONCLUSIONS
In some patients, paradoxically, lipid formulations of amphotericin B may be less tolerable than conventional amphotericin B.
Department of Internal Medicine C, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petach Tikva, Israel.
J
J
Bishara
M
M
Weinberger
A Y
AY
Lin
S
S
Pitlik
D058186:Acute Kidney Injury / Q000139:chemically induced; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy; D003102:Colloids; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008081:Liposomes
D000935:Antifungal Agents; D003102:Colloids; D008081:Liposomes; D000666:Amphotericin B