Gill J, Sprenger H R, Ralph E D, Sharpe M D
Program in Internal Medicine, University of Western Ontario, London, Canada.
Ann Pharmacother. 1999 Jun;33(6):683-5. doi: 10.1345/aph.18181.
To report a case of possible amphotericin B-induced hepatotoxicity in a patient with pulmonary blastomycosis.
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.
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.
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.
报告1例肺芽生菌病患者可能由两性霉素B引起肝毒性的病例。
1例患有危及生命的肺芽生菌病的26岁白人男性，在初始使用伊曲康唑治疗的基础上加用两性霉素B后出现肝酶升高。停用两性霉素B后肝毒性迅速消退，仅用伊曲康唑成功治愈了芽生菌病。
该病例说明了与短期使用两性霉素B相关的罕见肝毒性情况。肝活检结果与药物引起的改变相符，未显示芽生菌病的证据。停用两性霉素B且无其他治疗调整后，肝毒性迅速消退。基于每种药物的作用机制推测，伊曲康唑和两性霉素B之间可能存在药物不良相互作用。
两性霉素B治疗可能会伴有多种不良反应，但肝毒性报告罕见。对接受两性霉素B治疗的患者，尤其是与包括唑类抗真菌药物在内的潜在肝毒性药物联合使用时，应更密切监测肝酶。
