Hepatotoxicity possibly caused by amphotericin B

OBJECTIVE: TO report a case of possible amphotericin B-induced hepatotoxici ty in a patient with pulmonary blastomycosis. SUMMARY: A 26-year-old white man with life-threatening pulmonary blastomyco sis developed elevation of his liver enzymes after the addition of amphoter icin B to his initial itraconazole therapy. The hepatotoxicity resolved rap idly with discontinuation of the amphotericin B, and the blastomycosis was successfully treated with itraconazole alone. DISCUSSION: This case illustrates an unusual occurrence of hepatotoxicity a ssociated with a short course of amphotericin B. Liver biopsy was compatibl e with drug-induced changes and showed no evidence of blastomycosis. Discon tinuation of amphotericin B with no other therapeutic changes resulted in a rapid resolution of hepatotoxicity. A possible adverse drug interaction wi th itraconazole and amphotericin B is postulated based on the mechanism of action of each drug. CONCLUSIONS: Amphotericin B therapy can be associated with many adverse eff ects, but reports of hepatotoxicity are rare. Closer monitoring of liver en zymes in patients receiving amphotericin B, especially in combination with potentially hepatotoxic agents, including azole antifungal drugs, would be prudent.