Anaemia due to Amphotericin B a Double Whammy in Postoperative Mucormycosis Patients: A Case Series

Ruchi Kapoor; Ganga Dutt Devaraj; Ajeeb Sharahudeen; Jubin Jakhar

doi:10.18502/aacc.v8i2.9159

Ruchi Kapoor Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India.
Ganga Dutt Devaraj Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India.
Ajeeb Sharahudeen Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India.
Jubin Jakhar Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India.

DOI: https://doi.org/10.18502/aacc.v8i2.9159

Keywords: COVID-19; Mucormycosis; Anaemia; Amphotercin B

Abstract

Corona Virus Disease (COVID-19) which has a common association with diabetes has led to an epidemic of mucormycosis which has been mainly attributed to rampant use of steroids owing to the severity of the disease. The mucormycosis patients presented with rhino orbital mucormycosis predominantly with or without intracranial extension making it a life-threatening condition mandating urgent debridement as treatment of choice alongside antifungal medications. Injection Amphotericin B is the first-line drug that is nephrotoxic and causes dyselectrolytemia therefore administered under strict supervision.

However, we report successful management of two unique cases where patients after surgical debridement after Amphotericin B developed severe life-threatening anaemia postoperatively along with impending respiratory failure requiring Intensive care management including non-invasive ventilation. Thus, serial haematocrit monitoring is of utmost importance while the patient is being administered Amphotericin B even when a patient is receiving the relatively safe preparation that is liposomal Amphotericin B in a dose of 3.5 mg per kg body weight.