Respiratory distress secondary to both amphotericin B deoxycholate and lipid complex formulation
Rolland, W.A.; Guharoy, R.; Ramirez, L.; Blair, D.; Medicis, J.; Khan, U.
Veterinary and Human Toxicology 42(4): 222-223
2000
ISSN/ISBN: 0145-6296 PMID: 10928687 Document Number: 512196
A case is reported in a 73-year-old woman from New York, USA , with a history of adenocarcinoma of the colon and refractory anaemia, who developed febrile neutropenia following chemotherapy. Therapy with an intravenous infusion of amphotericin B deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature approx. 100 minutes into the infusion. The infusion was temporarily discontinued and rigors subsided following administration of 25 mg meperidine im. Infusion was continued after cessation of the rigors with no further sequelae. During each infusion of AmBd over the next 3 d, the patient developed rigor, chill and elevated temperature which was managed with meperidine. However, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion was stopped and the symptoms subsided with administration of albuterol via nebulizer. Amphotericin lipid formulation infusion was reinstituted after 3 days because of the patient's worsening clinical status. However, the patient developed severe respiratory distress approx. 130 minutes into the infusion. The infusion was discontinued and she was treated with albuterol via nebulizer. Itraconazole therapy was instituted without any adverse sequelae.