amphotericin-b and Hypoparathyroidism

To report a case of transient hypoparathyroidism that developed in a beta-thalassemic patient due to amphotericin B-induced hypomagnesemia. CASE SIJMMARY: A 21-year-old man with beta-thalassemia was treated with amphotericin B for Candida albicans intravenous line sepsis. After five days of treatment (cumulative dose 160 mg), he developed hypomagnesemia, which caused hypoparathyroidism and hypocalcemia; all three abnormalities resolved after the drug was withdrawn.. Patients with beta-thalassemia may develop endocrinologic abnormalities due to excessive iron deposition. Some may have subclinical hypoparathyroidism that clinically emerges after even a mild homeostasis disturbance. Amphotericin B is associated with variable adverse effects including renal tubular insult, which may induce hypomagnesemia following relatively short treatment. The resolution of hypomagnesemia, hypocalcemia, and hypoparathyroidism in our patient after discontinuation of amphotericin B treatment suggests that the endocrine dysfunction was due to a drug-related adverse effect and not to parathyroid dysfunction caused by iron deposition.. This case demonstrates a known but rarely reported adverse effect of amphotericin B, namely hypomagnesemia, that may occur even at a low cumulative dose. It also emphasizes that patients with an underlying disease, such as thalassemia, may be more susceptible to hypoparathyroidism and hypocalcemia during treatment with amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; beta-Thalassemia; Candidiasis; Humans; Hypocalcemia; Hypoparathyroidism; Kidney; Magnesium; Male

6 months before admission a 21-year-old woman had developed anogenital condylomata acuminata (CA). Since early childhood she had been treated for primary hypoparathyroidism (PHPT) and recurrent mucocutaneous candidiasis. 5 years before admission corneal clouding had caused visual impairment. Recently, mainly truncal vitiligo with occipital poliosis had developed.. PHPT was confirmed (parathormone level 7.7 mg/l). In addition, liver transaminases were raised (GOT 105.8 U/l, GPT 145.6 U/l, gamma-GT 56.8 U/l), pointing to noninfectious hepatitis. An ACTH stress test could not exclude manifest adrenocortical insufficiency, and thyroid function was also normal. The Merieux Multitest indicated an anergy.. The constellation of test results suggested autoimmune polyglandular syndrome type I. The condylomata were treated by electrocautery and the intestinal candidiasis with amphotericin B suspension. Calcitriol capsules, 0.5 microgram, and calcium gluconate or lactate, 500 and 300 mg respectively, 3 times daily each, were given for the PHPT.. This case demonstrates a complex syndrome which can be recognized early by simple clinical tests. Early diagnosis prevents possible life-threatening complications.

Topics: Adult; Amphotericin B; Antifungal Agents; Anus Diseases; Calcitriol; Calcium Gluconate; Candidiasis, Chronic Mucocutaneous; Capsules; Condylomata Acuminata; Corneal Opacity; Drug Therapy, Combination; Electrocoagulation; Female; Humans; Hypoparathyroidism; Lactates; Polyendocrinopathies, Autoimmune; Scalp; Suspensions; Vaginal Diseases; Vitiligo

Use of transfer factor in the treatment of chronic mucocutaneous candidiasis is discussed. The clinical experience in treating 2 patients with different clinical expressions of the syndrome and their different responses to treatment with repeated injections of transfer factor given in conjunction with amphotericin-B are reported. Results indicate that this form of therapy is a safe and effective way of restoring cell-mediated immunity to Candida and successfully treating some patients with chronic mucocutaneous candidiasis.

Topics: Amphotericin B; Candida albicans; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Female; Humans; Hypoparathyroidism; Immunity, Cellular; Immunologic Deficiency Syndromes; Lymphocyte Activation; Paronychia; Skin Tests; Thymidine; Transfer Factor; Tritium; Vitiligo

Topics: Addison Disease; Administration, Cutaneous; Adrenal Insufficiency; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Gentian Violet; Humans; Hypoadrenocorticism, Familial; Hypoparathyroidism; Nystatin; Sweden