Respiratory distress secondary to both amphotericin B deoxycholate and lipid complex formulation

A 73-y-old female with a history of adenocarcinoma of colon and refractory anemia developed febrile neutropenia following chemotherapy. Therapy with i v infusion of amphotericin B deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature app roximately 100 min into the infusion. The infusion was temporarily disconti nued and rigors subsided following administration of 25 mg meperidine im. I nfusion was continued after cessation of the rigors with no further sequela e. During each infusion of AmBd over the next 3 d. the patient developed ri gor, chill and elevated temperature which was managed with meperidine. Howe ver, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion wa s stopped and the symptoms subsided with administration of albuterol via ne bulizer. Amphotericin lipid formulation infusion was reinstituted after 3 d because of the patient's worsening clinical status. However, the patient d eveloped severe respiratory distress approximately 130 min into the infusio n. The infusion was discontinued and she was treated with albuterol via neb ulizer. Itraconazole therapy was instituted without any adverse sequelae. C linicians should be aware of this potential adverse event since it can occu r with all formulation of amphotericin.