A 36-year-old man with acute myelogenous leukemia undergoing induction chemotherapy develops persistent fever to 39.4°C despite seven days of broad-spectrum antibiotics, including piperacillin-tazobactam and vancomycin. His absolute neutrophil count is 200/mm³, and he has an indwelling central venous catheter. Blood cultures drawn from the catheter grow Candida albicans on two separate occasions, and he is started on a potent antifungal agent administered intravenously. Within one hour of the first infusion, he develops shaking rigors, worsening fever, and hypotension with a blood pressure of 88/54 mmHg. Over the following week, his serum creatinine rises from 0.9 mg/dL to 3.4 mg/dL with associated hypokalemia and hypomagnesemia. Which of the following best describes the mechanism of the most likely drug responsible for these findings?
- A)Inhibition of lanosterol 14-alpha-demethylase
- B)Conversion to a toxic free radical that damages fungal DNA
- C)Inhibition of fungal microtubule assembly
- D)Inhibition of fungal beta-glucan synthesis
- E)Binding ergosterol to create membrane poresGABARITO
Explicação
Amphotericin B binds ergosterol in fungal cell membranes, forming pores that increase permeability and lead to cell death. Infusion reactions and nephrotoxicity are classic adverse effects. The severe systemic fungal infection plus fever, rigors, and rising cr... Ver explicação completa e trilha adaptativa →