First Infant Desensitization to Liposomal Amphotericin B

Liposomal amphotericin B is the first-line treatment for Visceral leishmaniasis; however, drug hypersensitivity reactions, such as anaphylaxis, can pose significant challenges. Desensitization protocols are an option when alternative treatments are lacking. A 7-month-old female infant presented with persistent fever, pallor, splenomegaly, and laboratory findings suggestive of Visceral leishmaniasis with secondary hemophagocytic lymphohistiocytosis (HLH). After developing anaphylaxis following the first dose of liposomal amphotericin B (3 mg/kg), a 14-step desensitization protocol was successfully implemented, allowing continuation of therapy without complications. After completing the course of treatment, the patient's fever resolved, spleen size normalized, and hematological parameters improved. Causality assessment using the Naranjo scale indicated a "probable" adverse drug reaction (score = 6). This case represents the first reported successful use of a standard liposomal amphotericin B desensitization protocol in an infant under 1 year, demonstrating its feasibility and safety in managing anaphylaxis in endemic areas.