DRESS Syndrome Associated with Liposomal Amphotericin-B in a Kidney Transplant Patient: A Case Report

Abstract

Introduction: Liposomal amphotericin B is a widely used broad-spectrum antifungal drug. It was developed to reduce nephrotoxicity and maximize the therapeutic utility of amphotericin B in the treatment of invasive fungal infections. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity syndrome commonly associated with aromatic antiepileptic drugs. Liposomal amphotericin-B was associated with DRESS syndrome in only one case. Case Report: We report an exceptional case of possible DRESS syndrome associated with Liposomal amphotericin B in a 31-year-old male, renal transplant recipient. Seventeen days after starting Liposomal amphotericin B for visceral leishmaniosis, he developed a skin rash, with elevated liver tests. Liposomal amphotericin B was discontinued. A favourable outcome was slowly observed in one month. Results and Conclusion: This case was scored two (possible case) based on the criteria adopted by the European group RegiSCAR. The Naranjo score for Liposomal amphotericin B was four (possible).

Epidemiology, Clinical Characteristics, Diagnostic Work Up, and Treatment Options of Leishmania Infection in Kidney Transplant Recipients: A Systematic Review

“…At the end of the process, we included 66 retrospective case reports and 4 retrospective case series. According to the modified Newcastle–Ottawa Scale, 11 items were classified as low-quality [ 7 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], 34 as average-quality [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], and 25 as high-quality studies [ 4 , 10 , 59 , 60 , 61 …”

“…Maintenance immunosuppression was very heterogeneous. Most patients were on a CNI-based triple-agent scheme with tacrolimus ( n = 54) [ 17 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 30 , 31 , 34 , 40 , 41 , 49 , 58 , 59 , 62 , 66 , 72 , 73 , 79 , 81 ] or cyclosporin ( n = 45) [ 4 , 17 , 29 , 30 , 33 , 35 , 36 , 39 , 40 , 45 , 46 , 47 , 50 , 51 , 53 , 54 , 60 , 61 , 63 , 64 , 65 , 69 , 70 , 71 , 74 , 75 , 78 , 79 ], AZA ( n = 51) […”

“…The most frequently reported form of Leishmaniasis was VL ( n = 149) [ 4 , 7 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 59 , 60 , 61 , 63 , 64 , 65 , 66 , 67 , 69 , 70 , 71 , 72 , 73 , ...…”

“…Isolated anemia was reported in seven cases [ 17 , 40 , 64 , 75 ], isolated leukopenia in two [ 48 , 71 ], concomitant anemia and leukopenia in six [ 29 , 60 , 65 , 67 , 74 , 76 ], and associated leukopenia and thrombocytopenia in five [ 34 , 39 , 64 , 78 ]. Eleven cases were simply described as VL, with no data on symptoms or laboratory findings [ 16 , 19 , 20 , 41 , 44 ]. The main symptoms and laboratory findings of post-transplant Leishmaniasis are summarized in Table 3 .…”

“…Treatment was reported for 156/159 (98.1%) patients. Fist-line therapy mostly consisted of liposomal amphotericin B ( n = 98) [ 4 , 10 , 17 , 20 , 22 , 24 , 25 , 26 , 27 , 30 , 31 , 32 , 40 , 41 , 43 , 44 , 49 , 54 , 58 , 59 , 64 , 66 , 72 , 73 , 77 , 79 , 81 ] or pentavalent antimonial ( n = 44) [ 7 , 15 , 16 , 17 , 18 , 19 , 28 , 29 , 33 , 36 , 38 , 39 , 42 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 57 , …”