Amphotericin-B liposomal
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Non-occlusive ST-segment elevated myocardial infarction: case report A 52-year-old man developed non-occlusive ST-segment elevated myocardial infarction (STEMI) during treatment with amphotericin-B liposomal for cryptococcal meningitis [outcome not stated]. The man presented to the emergency department with new onset seizures. The patient had a history of hospitalisation due to left insular cortex cerebrovascular accident 3 months prior. Anamnesis revealed that he fell down and became unresponsive and developed generalised convulsions. He regained consciousness soon; however, he began to experience intermittent episodes of disorientation and confusion thereafter. He reported a 3-month history of severe bilateral frontal headache associated with frequent vomiting. His past medical history was significant for dyslipidaemia, hypertension, type II diabetes mellitus, obstructive sleep apnoea and atherosclerotic cardiovascular disease (underwent percutaneous coronary intervention of the left anterior descending (LAD) artery several months prior). Based on the findings of physical examination, CT angiography, MRI, lumbar puncture and CSF analysis, he was diagnosed with cryptococcal meningitis. He was treated with amphotericin-B liposomal infusion 3 mg/kg every 24 hours and flucytosine. However, he developed chest pain while receiving the first infusion of amphotericin-B liposomal. The rate of amphotericin-B liposomal infusion was slowed and the complete dose was administered. Thereafter, the man developed sweating, central chest pain, nausea and shortness of breath after the second dose of amphotericin-B liposomal. Vital sign examination revealed the following: body temperature 96.7°F, HR 69 beats/minute and BP 145/69mm Hg. ECG findings revealed ST-segment elevations in anterolateral leads and a mild elevation in troponin-I was also noted. Based on these findings, he was diagnosed with non-occlusive STEMI, and was treated with heparin, aspirin and ticagrelor. Further catheterisation showed 90% stenosis of distal LAD. Amphotericin-B liposomal was stopped and fluconazole was added to his treatment regimen. Due to risk of interaction with fluconazole, his ticagrelor therapy was discontinued. Subsequently, he completed flucytosine therapy and continued to receive fluconazole monotherapy. Kullab SM, et al. Non-occlusive ST-segment elevated myocardial infarction following the administration of liposomal amphotericin B in the treatment of cryptococcal 803504491 meningitis. Journal of Clinical Pharmacy and Therapeutics 45: 1168-1171, No. 5, Oct 2020. Available from: URL: http://doi.org/10.1111/jcpt.13109
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Reactions 3 Oct 2020 No. 1824
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