Table 1 Previously published cases of anaphylaxis and cardiac toxicity to LAmB

DeMonaco et al. (Drug Intelligence Clinical Pharmacology)[8]^a

1983

76-year-old semi-comatose patient with renal failure who experienced two episodes of transient asystole associated with hyperkalaemia and supratherapeutic digoxin levels, temporally associated with amphotericin B infusion

First reported case of possible clinical cardiac toxicity

Laing et al. (Lancet) [12]

1994

29-year-old AIDS patient developed hypotension, erythema, fever, bronchospasm and facial oedema shortly after commencing LAmB infusion. Recovered after administration of IV adrenaline and hydrocortisone. No reaction to subsequent therapy with conventional amphotericin B

Likely reaction to liposomal component or excipient, given patient tolerated intravenous conventional amphotericin B after the reaction

Torre et al. (Annals of Pharmacotherapy)[16]

1996

10-year-old with Crohn’s disease, treated with LAmB for candidaemia. On Day 4 of treatment, developed diffuse erythema. On D5, developed flushing, erythema, hypertension, bradycardia and bronchospasm, treated with IV methylprednisolone. Not rechallenged

The delayed time course is atypical for IgE mediated anaphylaxis in this case

Schneider et al. (British Journal of Haematology)[13]

1998

40-year-old with haematological malignancy. Previously tolerated oral amphotericin B without reaction. Developed hypotension, asystole and bronchospasm shortly after LAmB infusion. Death 36 h later secondary to resultant cerebral oedema

Likely reaction to liposome component or excipient, given pt had tolerated oral amphotericin B formulation previously

el-Dawlatly et al. (Middle East Journal of Anaesthesiology)[11]

1999

39-year-old with systole during amphotericin B infusion for systemic aspergillosis. Associated with hyperkalaemia

Possible anaphylaxis, although acute hyperkalaemia is alternative explanation

Vaida et al. (Annals of Pharmacotherapy)[14]

2002

2-year-old with haematological malignancy. Tolerated intravenous amphotericin B deoxycholate without reaction. Changed to LAmB to manage supplementary potassium requirements. Shortly after commencing infusion, child became agitated, then developed erythema and facial swelling. Treated with oxygen and IV hydrocortisone, with complete resolution. Tolerated oral amphotericin B deoxycholate subsequently without complication

Likely reaction to liposomal component or excipient, given patient tolerated intravenous and oral formulations of conventional amphotericin B before and after the reaction

Groot et al. (Netherlands Journal of Medicine)[9]

2008

36-year-old received multiple doses of LAmB, 4 of which were associated with hyperkalaemia, the last of which resulted in fatal cardiac arrest

Appears to be a progressive dose- and time-related reaction

Kholve et al. (Journal of Antimicrobial Chemotherapy)[17]

2009

2 reported anaphylactic reactions in case series of 84 children receiving prophylactic or therapeutic LAmB in the context of malignancy/haematopoietic stem cell transplant

No detailed information about these reactions provided

Anonymous [Reactions Weekly (Aukland)] (not peer reviewed) [18]

2012

38-year-old with haematological malignancy commenced on LAmB, developed chest pressure, hypotension, hypoxia and dyspnoea shortly after commencing infusion. Resolved with IV fluid, steroids and diphenhydramine. Successful administration of LAmB following “desensitisation” by administering full dose over 11 h

Possible anaphylactic reaction although no reaction following subsequent administration raises some doubt

Sanches et al. (BMJ Case Reports) [10]

2014

9-month old developed atrioventricular blockade following 3 days of LAmB therapy, resolving on sessation of LAmB

Appears to be a progressive dose- and time-related reaction