Axiotakis Lucas G, Enver Necati, Keating Claire L, Pitman Michael J
Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY; Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY.
Chest. 2021 Apr;159(4):e185-e187. doi: 10.1016/j.chest.2020.11.045. Epub 2021 Apr 6.
Inhaled antibiotics have long been used for chronic lung infections, especially in patients with cystic fibrosis and increasingly for non-cystic fibrosis bronchiectasis. Amikacin liposome inhalation suspension (ALIS) has emerged as a promising treatment for Mycobacterium avium complex infection refractory to oral antibiotics. However, despite its efficacy, nearly one-half of patients in phase II and III trials experienced dysphonia as a treatment-associated adverse effect. Here, we describe a patient who experienced severe, acute-onset laryngitis while receiving ALIS for refractory M avium complex infection, prompting discontinuation of ALIS therapy. This is the first report directly describing vocal fold injury due to such therapy. Given the high frequency of dysphonia reported with ALIS, this case highlights the potential severity of laryngeal toxicity, the importance of coordination of care for patients receiving inhaled antibiotics for chronic pulmonary disease, and the need for better insight into mechanisms of toxicity.
吸入性抗生素长期以来一直用于慢性肺部感染，尤其是囊性纤维化患者，并且越来越多地用于非囊性纤维化支气管扩张症。阿米卡星脂质体吸入混悬液（ALIS）已成为治疗对口服抗生素难治的鸟分枝杆菌复合体感染的一种有前景的疗法。然而，尽管其疗效显著，但在II期和III期试验中，近一半的患者出现了作为治疗相关不良反应的发音困难。在此，我们描述了一名在接受ALIS治疗难治性鸟分枝杆菌复合体感染时发生严重急性喉炎的患者，这促使停用ALIS治疗。这是第一份直接描述此类治疗导致声带损伤的报告。鉴于ALIS报告的发音困难发生率很高，该病例凸显了喉毒性的潜在严重性、对接受吸入性抗生素治疗慢性肺病患者进行护理协调的重要性，以及深入了解毒性机制的必要性。
