• PDF / 170,146 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 65 Downloads / 153 Views

DOWNLOAD

REPORT

---

1 S

Amphotericin-B-liposomal/posaconazole/voriconazole Non-sustained wide complex ventricular tachycardia: case report

An 8-year-old boy developed non-sustained wide complex ventricular tachycardia during treatment with amphotericin-Bliposomal, posaconazole and voriconazole for pulmonary aspergillosis. The boy, who had invasive pulmonary aspergillosis with multiple aspergillomas involving both lungs, received treatment with oral posaconazole 300mg twice daily and IV infusion of amphotericin-B-liposomal [Ambisome] 90mg (3 mg/kg) daily through a Hickman catheter over one hour. Additionally, he was receiving treatment with tacrolimus concomitantly. He experienced feeding intolerance with severe abdominal pain [aetiology not stated] due which the enteral feeding was temporarily stopped. Thereafter, the treatment with posaconazole was switched to IV voriconazole 210mg every 12 hours. Five days following the combine treatment of voriconazole and amphotericin-B-liposomal, he developed an attack of non-sustained wide complex ventricular tachycardia, which lasted for 24 seconds. After thirty seconds, he had three similar attacks lasted for 15, 2 and 4 seconds, respectively with an interval duration of 1 second in between. During the attacks, he was asymptomatic, and received continuous renal replacement therapy at that juncture. An ECG performed immediately after the event had not captured the ventricular tachycardia showed a QT interval of 0.42 seconds. Few days thereafter, the asymptomatic ventricular ectopics reappeared during amphotericin-B-liposomal infusion. Based on these findings and clinical presentation, it was concluded that the non-sustained wide complex ventricular tachycardia was associated with amphotericin-B-liposomal, posaconazole and voriconazole [not all durations of treatments to reaction onset stated]. The boy’s treatment with voriconazole was then changed back to oral posaconazole since his enteral feeding was re-established. Subsequently, the administration duration of amphotericin-B-liposomal was increased to two hours, and no recurrence of ventricular tachycardia was observed. Hui WF, et al. Arrhythmias Associated with Administration of Anti-fungal Agents. Indian Pediatrics 57: 775-776, No. 8, Aug 2020. Available from: URL: http:// doi.org/10.1007/s13312-020-1944-1

0114-9954/20/1822-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

803501441

Reactions 19 Sep 2020 No. 1822