Deoxycholate amphotericin for histoplasmosis in a patient with poor kidney function

2021 ◽  
Vol 14 (8) ◽  
pp. e243984
Author(s):  
Gokul Krishnan ◽  
Nitin Gupta ◽  
Kavitha Saravu ◽  
Handattu Manjunath Hande ◽  
Ruchee Khanna
Keyword(s):  
Bone Marrow ◽  
Amphotericin B ◽  
Kidney Function ◽  
Liposomal Amphotericin ◽  
Financial Constraints ◽  
Bone Marrow Examination ◽  
Liver And Kidney ◽  
Oral Itraconazole ◽  
Intravenous Amphotericin ◽  
Living With Hiv

A 48-year-old male patient living with HIV presented to our hospital with fever and weight loss. On evaluation, he was found to have pancytopenia, deranged liver and kidney function. CD4 count was 13 cells/uL. Bone marrow examination done because of pancytopenia showed yeast forms of histoplasmosis. Although liposomal amphotericin B is preferred for induction, he was treated with deoxycholate amphotericin B despite poor kidney function because of financial constraints. He was treated for 12 days with intravenous amphotericin, during which his clinical condition significantly improved. He was discharged on oral itraconazole.

Possible Liposomal Amphotericin B–Induced Nephrogenic Diabetes Insipidus

2003 ◽  
Vol 37 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Todd W Canada ◽  
Lisa M Weavind ◽  
Kristan M Augustin
Keyword(s):  
Bone Marrow ◽  
Diabetes Insipidus ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Serum Sodium ◽  
Liposomal Amphotericin ◽  
Nephrogenic Diabetes Insipidus ◽  
Marrow Transplant ◽  
Liposomal Amphotericin B ◽  
High Dose

OBJECTIVE To report the development of nephrogenic diabetes insipidus (NDI) associated with the use of high-dose liposomal amphotericin B. CASE SUMMARY A 38-year-old white man with relapsed acute myelogenous leukemia underwent a matched unrelated donor allogeneic bone marrow transplant with adequate engraftment and mild graft-versus–host disease responding to corticosteroids. Approximately 11 months after transplant, the patient was admitted to the hospital with suspected fungal pneumonia and started on liposomal amphotericin B (baseline serum creatinine 1.4–1.5 mg/dL). The dose was increased due to his immunosuppression and poor response, as the fungal etiology was identified as Torulopsis glabrata. The patient required mechanical ventilation due to biopsy-proven bronchiolitis olbiterans organizing pneumonia. Additionally, he developed diffuse alveolar hemorrhage and received intravenous desmopressin, with a reduction in bloody secretions. He also developed hypernatremia (serum sodium 155 mEq/L) on day 3 of the desmopressin and had an inappropriately increased urine output consistent with NDI. The most likely etiology for the NDI was liposomal amphotericin B and its associated hypokalemia. DISCUSSION The observation of worsening hypernatremia (serum sodium increased from 135 to 164 mEq/L) with polyuria was associated with an increasing cumulative dosage of liposomal amphotericin B for fungal pneumonia despite the concurrent use of intravenous desmopressin. Aggressive water replacement was an effective treatment option in this patient. The Naranjo probability scale classified this as a possible adverse reaction because of the temporal sequence of NDI after high-dose liposomal amphotericin B and previously reported cases of NDI associated with amphotericin B desoxycholate. CONCLUSIONS Amphotericin B desoxycholate has been implicated as an etiology for NDI, and the use of the newer liposomal amphotericin B reportedly avoids this rare complication. We observed the development of NDI despite the use of liposomal amphotericin B in a critically ill patient with bone marrow transplant.

Amphotericin B deoxycholate versus liposomal amphotericin B: effects on kidney function

2008 ◽  
Author(s):  
Jason M Cota ◽  
James N Barnes ◽  
Bradi Frei ◽  
Christopher R Frei ◽  
Nathan P Wiederhold
Keyword(s):  
Amphotericin B ◽  
Kidney Function ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Amphotericin B Deoxycholate
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