Case Report
Fatal fat embolism following amphotericin B lipid complex injection

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Abstract

A case of amphotericin B lipid complex induced fatal fat embolism is described. A 41-year-old Caucasian man with AIDS was undergoing treatment for cryptococcal meningitis with amphotericin B. His course was complicated by renal failure necessitating a change in therapy to amphotericin B lipid complex (Abelcet). At approximately 48 h, the patient developed tachycardia, tachypnea, respiratory failure, decline in hematocrit, thrombocytopenia, and alteration in mental status. Autopsy findings included fat emboli involving heart, lungs, kidney, and brain. To our knowledge, this is the first case report of a fatal fat embolism caused by intravenous liposome drug delivery.

Section snippets

Introduction (case report)

The patient was a 41-year-old Caucasian who had been diagnosed with AIDS 6 months before admission with a CD4 count of 41 cells/mm3; he was nonadherent with antiretroviral therapy. He presented to the emergency department with a headache for 10 days, photophobia, ataxia, nausea, vomiting, and somnolence. His medications included aspirin only. Vital signs on admission revealed a temperature of 101.3°F, pulse rate of 77 beats/min, and blood pressure of 130/94 mm Hg. Physical examination was

Discussion

This patient manifested the signs and symptoms consistent with fat embolism approximately 48 h after starting amphotericin B lipid complex injection (Abelcet), namely, tachycardia, respiratory insufficiency, coma, anemia, and thrombocytopenia. Evidence of fat embolism included diffuse deposits of fat globules in the capillaries and small arterioles of the heart, lungs, kidney, and brain (Table 2).

The pathogenesis of this symptom complex is believed to involve both mechanical obstruction and

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