Acute Pancreatitis by liposomal amphotericin B

Resumen

We present the case of an  88-year-old male, not known allergies,with medical history of arterial hypertension, Grade IV chronic kidney disease . His last hospitalisation was 1 month ago for a pneumonia, acute kidney injury, atrial fibrillation  and pancytopenia. Two weeks later, he went to the Urgency Department for severe deterioration of the general condition, fever, and a skin rash  which were attributed to an allergic late reaction to levofloxacin.  His treatment was wich acetylsalicylic acid 100 mg, digoxin, methamizole, pantoprazole, valsartan/amlodipine

 The Lab results showed pancytopenia . It was performed a bone marrow aspirate suggestive of leishmaniosis. It was initiated treatment intravenous with LAB at 3 mg / kg / day . The first day of treatment, the patient showed a severe bronchospasm, exacerbation of previous rash by quinolones, was treated with corticosteroids, antihistamines, aerosoltherapy and oxygen therapy with full recovery.

During the following days LAB was administrated at a slower administration and premedication (corticosteroids, and antihistamines) with appropriate tolerance. The fifth day of the treatment the patient started with an abdominal pain radiating in belt, anorexia and vomiting. The lab result of amylase was 431 IU/L. An abdominal scanner showed edematous pancreatitis. After 48 hours lab results of amylase  and lipase were normal. And the abdominal Scanner was repeated with no changes. The evolution of patient was towards worsening to multiple organs failure and few days later he died.