Amphotericin B liposome-induced acrocyanosis and elevated serum creatinine

Area of Science:

• Mycology
• Pharmacology
• Nephrology

Background:

• Disseminated histoplasmosis is a serious fungal infection requiring systemic antifungal therapy.
• Amphotericin B formulations, including liposomal amphotericin B, are commonly used for histoplasmosis treatment.
• Adverse drug reactions can complicate antifungal therapy, necessitating careful monitoring and management.

Observation:

• A 77-year-old male patient presented with acrocyanosis and pain following intravenous amphotericin B liposome administration for disseminated histoplasmosis.
• The patient subsequently developed elevated serum creatinine, indicating potential nephrotoxicity.
• Discontinuation of amphotericin B liposome and initiation of intravenous anisodamine therapy were performed.

Findings:

• The patient experienced probable adverse drug reactions attributed to amphotericin B liposome, with a Naranjo scale score of 5.
• Anisodamine treatment for 9 days successfully resolved the acrocyanosis and pain.
• Serum creatinine levels normalized, suggesting recovery from potential kidney injury.

Implications:

• This case highlights the potential for acrocyanosis, pain, and nephrotoxicity as adverse effects of liposomal amphotericin B.
• Anisodamine may be an effective therapeutic option for managing these specific adverse reactions.
• Clinicians should maintain a high index of suspicion for adverse drug reactions during amphotericin B liposome therapy and consider alternative management strategies.