Hypokalaemia-induced rhabdomyolysis after treatment of post-Kala-azar dermal Leishmaniasis (PKDL) with high-dose AmBisome in Bangladesh-a case report

• Published in: PLoS neglected tropical diseases 2014-06, Vol.8 (6), p.e2864
• Main Authors: Marking, Ulrika, den Boer, Margriet, Das, Asish Kumar, Ahmed, Elshafie Mohamed, Rollason, Victoria, Ahmed, Be-Nazir, Davidson, Robert N, Ritmeijer, Koert
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Amphotericin B - adverse effects; Amphotericin B - therapeutic use; Antiprotozoal Agents - adverse effects; Antiprotozoal Agents - therapeutic use; Bangladesh; Biology and Life Sciences; Case studies; Child; Clinical trials; Complications and side effects; Drug dosages; Drug therapy; Female; Humans; Hypokalemia; Hypokalemia - chemically induced; Hypokalemia - complications; Kala-azar; Leishmaniasis, Cutaneous - drug therapy; Leishmaniasis, Visceral - complications; Male; Medicine and Health Sciences; Microscopy; Parasitic diseases; Patient outcomes; Patients; Potassium; Rhabdomyolysis; Rhabdomyolysis - etiology; Rhabdomyolysis - pathology; Risk factors; Substance abuse treatment; Symposium; Urine; Young Adult
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0002864

  There are no evidence-based treatments for PKDL. [...]treatment can be considered experimental, and treatment choices are "best guesses" based on good results in small clinical studies and clinical experience in the field. Because PKDL in Bangladesh is a non-life-threatening condition that generally does not cause physical impairment and because treatment is mainly provided for public health reasons, the risk/benefit ratio of treatment for individual PKDL patients needs to be extremely low, using a very safe treatment. Because of the observed occurrence of life-threatening side effects, a 30 mg/kg total dose L-AMB regimen is not recommended as routine treatment for PKDL in Bangladesh. [...]research on the effectiveness and safety of a lower dose L-AMB regimen is currently planned in order to establish an effective, safe, and acceptable treatment for PKDL that does not require strict clinical and laboratory monitoring and that can be adopted in the National Kala Azar Elimination Programme in Bangladesh. [...]more is known about the safety of L-AMB in this particular setting, it may be advisable to monitor serum potassium levels in patients receiving L-AMB in cumulative doses of 20 mg/kg or more.