Sanches Bruno Fernandes, Nunes Pedro, Almeida Helena, Rebelo Mónica
Department of Pediatrics, Hospital Garcia de Orta, Almada, Portugal.
Department of Pediatric Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
BMJ Case Rep. 2014 Jun 6;2014:bcr2013202688. doi: 10.1136/bcr-2013-202688.
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.
房室传导阻滞可发生于正常儿童、年轻人或运动员。它也与潜在的心脏病有关，或作为药物不良反应出现。两性霉素B用于治疗侵袭性真菌感染。心脏毒性是一种罕见的不良反应。我们报告一例9个月大的女孩，因巨细胞病毒性肺炎入住儿科重症监护病房。住院期间，患者发生全身性真菌感染，接受了脂质体两性霉素B治疗。治疗第三天，她开始反复出现心动过缓，并能自行恢复。检查发现二度房室传导阻滞。我们排除了中心静脉导管位置不当、心肌炎或结构性心肌病，并停用了两性霉素。8天后，心动过缓发作停止，这与药物的半衰期相符。两性霉素的心脏毒性机制仍不清楚。它可能与心肌膜去极化改变有关。
