Amphotericin B liposome-induced acute cardiac dilatation and heart failure in a pediatric patient
10.3760/cma.j.cn114015-20241114-00150
- VernacularTitle:两性霉素B脂质体致小儿急性心脏扩张及心力衰竭
- Author:
Enpeng DAI
1
;
Yuan CHEN
1
;
Shibin YANG
1
;
Pan WANG
1
;
Ya TIAN
1
Author Information
1. 河北医科大学第二医院儿科，石家庄 050000
- Publication Type:Journal Article
- Keywords:
Amphotericin B;
Granulomatous disease, chronic;
Pulmonary arterial hypertension;
Heart failure;
Cardiac dilatation
- From:
Adverse Drug Reactions Journal
2025;27(11):699-702
- CountryChina
- Language:Chinese
-
Abstract:
An 8-year-old male patient with chronic granulomatous disease received amphotericin B liposome (unknown dose) in addition to anti-infection treatments with meropenem, compound sulfamethoxazole, and voriconazole due to recurrence of secondary pulmonary infection. After 3 days, the patient developed tachycardia, edema, and worsening dyspnea. Echocardiography revealed severe right heart enlarge- ment and pulmonary hypertension. Cardiotonic, diuretic, and pulmonary antihypertensive therapies were given. After over half a month, his pulmonary infection was improved, pulmonary arterial pressure decreased, but the right heart enlargement persisted. Suspending treatment about half a month later, amphotericin B liposome was reinitiated at a gradually increased dose from 2 mg once daily, in combination with piperacillin sodium and tazobactam sodium and compound sulfamethoxazole due to aggravated cyanosis and cough. After the administration of amphotericin B liposome (50 mg once daily) on day 5, the patient experienced wheezing and facial edema. Laboratory tests showed B-type natriuretic peptide (BNP) 4 679 ng/L; echocardiography demonstrated right heart enlargement and pulmonary hypertension. Suspecting that the cardiac dilatation and heart failure were associated with amphotericin B liposome, the drug was discontinued. The anti-infection regimen was switched to biapenem, linezolid and voriconazole, along with continued cardiotonic and diuretic managements. The patient′s symptoms were improved after 10 days, the treatment regimen was changed to compound sulfamethoxazole and voriconazole. However, after 3 days, the patient′s abdominal distension and dyspnea worsened. Endotracheal intubation and mechanical ventilation were initiated along with cardiotonic and diuretic therapy; anti-infection therapy with cefoperazone sodium and sulbactam sodium combined with voriconazole was given based on bronchoalveolar lavage fluid and sputum culture results. One month later, the patient′s condition was improved, showing no right ventricular dilation and reduced pulmonary arterial pressure on echocardiography and BNP 800 ng/L.
