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Pulmonary toxicity during infusion of liposomal amphotericin B in two patients with acute leukemia
M Arning1, A H Heer-Sonderhoff, A Wehmeier
1Heinrich-Heine-University Medical Center, Department of Haematology, Oncology and Clinical Immunology, Düsseldorf, Germany.
Abstract:
Pulmonary toxicity with acute dyspnea occurred during infusion of a liposomal amphotericin B preparation (AmBisome) in two adult leukemic patients. The preparation was administered as a one hour infusion at a dose of 3 mg/kg body weight. Within 15 min after starting the infusion, both patients experienced sudden onset of dyspnea and chest tightness. Physical examination showed the patients to be anxious and restless with tachycardia and orthopnea but without other cardiopulmonary findings. No elevation of body temperature, rigors or chills were recorded. Symptoms disappeared within minutes after discontinuing the infusion. At present, the pathophysiologic mechanisms underlying these side effects are unknown.
Insights
Acute pulmonary toxicity, including dyspnea, occurred during AmBisome infusion in two leukemia patients. Symptoms resolved quickly upon stopping the liposomal amphotericin B preparation.
Area of Science:
- Pharmacology
- Pulmonology
- Hematology
Background:
- Liposomal amphotericin B (AmBisome) is an antifungal agent used in treating invasive fungal infections.
- Leukemia patients often require aggressive treatment, increasing susceptibility to infections and necessitating antifungal therapies.
Observation:
- Two adult leukemia patients receiving AmBisome infusion experienced sudden onset of acute dyspnea and chest tightness.
- Symptoms manifested within 15 minutes of initiating the one-hour infusion at 3 mg/kg.
- Clinical presentation included anxiety, restlessness, tachycardia, and orthopnea, without fever or chills.
Findings:
- Infusion-related pulmonary toxicity was observed during AmBisome administration.
- Symptoms were transient, resolving rapidly upon discontinuation of the liposomal amphotericin B infusion.
- No significant cardiopulmonary abnormalities were detected beyond the acute symptoms.
Implications:
- This case series highlights a potential acute pulmonary adverse effect associated with AmBisome infusion.
- Further investigation into the pathophysiologic mechanisms underlying these infusion-related respiratory events is warranted.
- Clinicians should be aware of this potential toxicity when administering AmBisome to patients, particularly those with hematologic malignancies.