Micafungin-induced immune hemolysis attacks.
The echinocandins provide an attractive new option for prophylactic and empirical treatment of invasive fungal infections in patients with neutropenia after intensive cytotoxic chemotherapy or hematopoietic stem cell transplantation. We present two patients with hematological diseases who experienced massive intravascular hemolysis followed by renal failure after administration of micafungin. In indirect antiglobulin test, significant agglutination was observed when red blood cells were exposed to the mixture of micafungin and either of the patients' plasma samples, indicating that production of antibodies directed against both micafungin and red blood cell membrane induced hemolysis attack. Micafungin-mediated immune hemolysis represents an uncommon but life-threatening adverse reaction leading to renal failure.
Nanri
Tomoko
T
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Iwanaga
Eisaku
E
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Fujie
Satomi
S
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Yamada
Yasuhiro
Y
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Horikawa
Kentaro
K
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Mitsuya
Hiroaki
H
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Asou
Norio
N
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. ktcnasou@gpo.kumamoto-u.ac.jp.
D000917:Antibody Formation / Q000187:drug effects*; D000935:Antifungal Agents / Q000009:adverse effects; D054714:Echinocandins / Q000009:adverse effects* / Q000276:immunology; D004912:Erythrocytes / Q000276:immunology; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D055666:Lipopeptides / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin