Micafungin induced acute hemolytic reaction and acute kidney failure
10.3760/cma.j.issn.1008-5734.2014.05.019
- VernacularTitle:米卡芬净致急性溶血反应并肾衰竭
- Author:
Tianlai LIN
1
;
Xiaozhen CAI
1
;
Zhirong DING
1
;
Haiwen ZENG
1
Author Information
1. 362000,福建医科大学附属泉州第一医院重症医学科
- Publication Type:Journal Article
- Keywords:
Micafungin;
Hemolysis;
Kidney failure
- From:
Adverse Drug Reactions Journal
2014;(5):309-310
- CountryChina
- Language:Chinese
-
Abstract:
A 76-year-old male patient received an IV infusion of micafungin 50 mg in 0. 9% sodium chloride 100 ml once daily for pulmonary infection. Ninety minutes after the first infusion,the patient presented with chills,fever and dark brown urine. Laboratory testing showed the following levels:white blood cells count 25. 2 × 109/L,hemoglobin 73 g/L,platelet count 179 × 109/L,blood urea nitrogen 6. 4 mmol/L,serum creatinine 96 μmol/L,procalcitonin 14. 13 ng/ml,prothrombin time 17 s,activated partial thromboplastin time 44 s,D-dimer 8. 7 mg/L,and routine urine tests showed white blood cells( +++), urine occult blood test( +++),urobilinogen( +++),urine ketones( +++),urine protein( +++) and nitrite positive. The patient was considered as acute hemolysis. Micafungin was stopped. He was given an IV injection of methylprednisolone 40 mg and hydration and urinary alkalinization. However,his urine volume was reduced from 100-150 ml/h to 10-20 ml/h in 4 hours and developed dark urine. The following day,his white blood cells count was 18. 6 × 109/L,red cells count was 1. 7 × 1012/L,hemoglobin was 57 g/L,platelet count was 116 × 109/L,reticulocytes was 0. 05,albumin was 25 g/L,indirect bilirubin was 20. 4 μmol/L,aspartate transaminase was 108 U/L,alanine aminotransferase was 42 U/L,blood urea nitrogen was 17. 9 mmol/L,serum creatinine was 230μmol/L,and direct antiglobulin test was positive. He was considered to have acute kidney failure. The patient received anti-infective treatment,continuous renal replacement therapy,and infusion of erythrocyte suspension and plasma. Ten days later,the patient was still anuric and presenting worsening jaundice,family members gave up treatment.
