Amphotericin B Toxicity

ID/CC A 31-year-old truck driver visits a health clinic in San Diego complaining of recurrent infections (neutropenia), excessive bleeding (thrombocytopenia) and malaise, weakness, and apathy (anemia).

HPI He travels south of the border daily and eats and sleeps there. He has had typhoid fever three times over the past 5 years, for which he has been treated with high-dose chloramphenicol.

PE VS: no fever; BP normal. PE: marked pallor; lungs clear; heart sounds normal; generalized petechiae; abdominal and neurologic examination unremarkable.

Labs CBC: anemia (Hb 5.7); leukopenia; thrombocytopenia.

Imaging CXR/KUB: within normal limits.

Treatment Blood transfusions, antithymocyte globulin or cyclosporin, marrow transplan tation.

Discussion Chloramphenicol is a bacteriostatic antibiotic that acts by inhibiting peptidyl transferase in the 50S ribosomal unit. It is active against anaerobes (abdominal sepsis) and rickettsiae as well as against typhoid fever and meningococcal, streptococcal, and Haemophilus influenzae meningitis. Aplastic anemia is nonetheless a major problem. Some aplastic cases appear to be related to overdose, while others are related to hypersensitivity to the drug. In infants, it produces the gray-baby syndrome. Owing to its potentially fatal side effect of aplastic anemia, chloramphenicol is used primarily for serious infections or acute Salmonella typhi infection.

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