title: Atrioventricular block related to liposomal amphotericin B.
abstract: Atrioventricular block can occur in normal children, young adults or athletes. It is also associated with underlying heart disease or occurs as a drug adverse effect. Amphotericin B is used in the treatment of invasive fungal infections. Cardiac toxicity is a rare adverse reaction. We report the case of a 9-month girl, admitted in the paediatric intensive care unit with cytomegalovirus pneumonitis. During hospitalisation the patient developed a systemic fungic infection and was medicated with liposomal amphotericin B. On the third day of treatment she began repeated episodes of bradycardia with spontaneous reversion. The investigation revealed a second-degree atrioventricular block. We excluded the misplacement of the central catheter, myocarditis or structural cardiomyopathy and suspended amphotericin. After 8 days, the bradycardia episodes ceased what was consistent with the drug's half-life. Amphotericin cardiotoxic mechanism is still unclear. It may be related with alteration of myocardial membrane depolarisation.
authors.affiliation: Department of Pediatrics, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Bruno Fernandes
authors.initials: BF
authors.lastname: Sanches
authors.affiliation: Department of Pediatric Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Nunes
authors.affiliation: Department of Pediatric Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Almeida
authors.affiliation: Department of Pediatrics, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rebelo
mesh_terms: D000666:Amphotericin B / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects*; D054537:Atrioventricular Block / Q000139:chemically induced*; D058387:Candidemia / Q000188:drug therapy*; D066126:Cardiotoxicity; D005260:Female; D006801:Humans; D007223:Infant
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B