Wagner Jamie L, Bell Allison M
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA.
J Pharmacol Pharmacother. 2016 Apr-Jun;7(2):112-4. doi: 10.4103/0976-500X.184779.
Amphotericin B deoxycholate (AmBd) is rarely used due to its adverse effect profile, which includes nephrotoxicity, infusion-related reactions, and hepatotoxicity. The incidence of hepatotoxicity related to AmBd is 18-23%, but the reports of this adverse effect are mainly in immunocompromised patients receiving chemotherapy. We report a case of AmBd-related acute hepatic injury in an immunocompetent male with multiple medical problems. The patient initially had acute hepatic injury likely caused by poor nutritional status and a diagnosis of failure to thrive, but was recovering. He was also diagnosed with bilateral renal fungal mycetomas and received systemic treatment initially with micafungin and then fluconazole after urine cultures returned with the growth of Candida glabrata. Therapy was expanded to systemic AmBd when the fungal balls persisted. The patient subsequently developed hepatic re-injury with 1 dose of AmBd, and the therapy was discontinued. Caution should be exerted when utilizing AmBd in treating patients with previous hepatic injury.
两性霉素B脱氧胆酸盐（AmBd）因其不良反应，包括肾毒性、输液相关反应和肝毒性，很少被使用。与AmBd相关的肝毒性发生率为18%-23%，但关于这种不良反应的报告主要见于接受化疗的免疫功能低下患者。我们报告一例有多种内科问题的免疫功能正常男性发生AmBd相关急性肝损伤的病例。该患者最初因营养状况差和生长发育迟缓诊断而可能患有急性肝损伤，但正在恢复。他还被诊断为双侧肾真菌瘤，最初接受米卡芬净全身治疗，尿培养出光滑念珠菌生长后改用氟康唑。当真菌球持续存在时，治疗扩大至全身使用AmBd。患者随后在使用1剂AmBd后出现肝再损伤，治疗中断。在治疗既往有肝损伤的患者时使用AmBd应谨慎。
