Acute hepatic injury with amphotericin B deoxycholate in an immunocompetent patient

Area of Science:

• Medical Mycology
• Hepatology
• Clinical Pharmacology

Background:

• Amphotericin B deoxycholate (AmBd) is associated with significant adverse effects, including hepatotoxicity (18-23% incidence), primarily reported in immunocompromised patients.
• Fungal mycetomas, particularly those caused by Candida glabrata, necessitate systemic antifungal treatment.
• Prior hepatic injury or compromised nutritional status may increase susceptibility to drug-induced liver injury.

Observation:

• A case report details an immunocompetent male with multiple comorbidities and bilateral renal fungal mycetomas.
• The patient experienced initial hepatic injury, likely multifactorial, but was recovering before antifungal treatment.
• Systemic treatment with micafungin and fluconazole was initiated for Candida glabrata, followed by Amphotericin B deoxycholate due to persistent fungal balls.

Findings:

• The patient developed acute hepatic re-injury shortly after receiving a single dose of Amphotericin B deoxycholate.
• Amphotericin B deoxycholate therapy was discontinued due to the observed hepatotoxicity.
• This event underscores the potential for Amphotericin B deoxycholate to cause severe liver injury, even in non-chemotherapy patients.

Implications:

• Clinicians should exercise caution when prescribing Amphotericin B deoxycholate to patients with a history of hepatic injury.
• Further investigation into the specific mechanisms of Amphotericin B deoxycholate-induced hepatotoxicity in diverse patient populations is warranted.
• Risk-benefit assessment is crucial when considering Amphotericin B deoxycholate for fungal infections, particularly in patients with pre-existing liver conditions.