Amphotericin-B liposomal
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Acute kidney injury: case report A 35-year-old man developed acute kidney injury during treatment with amphotericin-B liposomal for disseminated coccidiomycosis. The man, who had a history of congenital deafness, asthma and hypertension presented with rash, shortness of breath, productive cough, worsening night sweats and intermittent back pain. He had been receiving fluconazole for valley fever (diagnosed 2 months prior). Laboratory tests revealed leucocytosis with predominant neutrophilia and anaemia of chronic disease. He was found positive for respiratory syncytial virus. Based on the findings of MRI, IgG ELISA and CT-guided biopsy, he was diagnosed with disseminated coccidioidomycosis. Thereafter, he was hospitalised to a University Hospital in San Antonio (USA), and was treated with high-flow nasal cannula oxygen therapy, unspecified IV fluids, itraconazole along with amphotericin-B liposomal [dosage and route not stated]; however, his RR continued to increase and he developed worsening hypoxaemia. Consequently, he was treated with unspecified vasopressors, and was transferred to the ICU and later intubated. Based on the findings of chest X-ray, he was diagnosed with acute respiratory distress syndrome and a community acquired pneumonia was suspected. In addition, he developed septic shock. Hence, ceftriaxone and azithromycin were added to his treatment regimen and itraconazole was switched to voriconazole. However, he developed acute kidney injury with a creatinine level of 4.2 mg/dL secondary to amphotericin-B liposomal use [duration of treatment to reaction onset not stated]. Subsequently, he developed paralytic ileus, right internal jugular deep vein thrombosis, and a gluteal haematoma [aetiologies unspecified]. The man’s pulmonary and renal recovery were achieved after several weeks of treatment with voriconazole and amphotericin-B liposomal. Eventually, he was discharged with a normal creatinine level. Dev A, et al. Disseminated Coccidioidomycosis Following Insufficient Treatment at Initial Presentation: Case Report. Journal of Investigative Medicine High Impact Case 803503834 Reports 8: 18 Aug 2020. Available from: URL: http://doi.org/10.1177/2324709620949315
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Reactions 26 Sep 2020 No. 1823
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