A Therapeutic Dilemma

Abstract

Six patients with disseminated coccidioidomycosis were treated with amphotericin B. Their therapy was guided by following the complement fixation titer, and treatment was continued until the titer fell to 116 or became stable. Renal function studies were performed during treatment. Renal biopsies, as well as blood gas and arterial pH studies, were performed on 3 patients. The systemic signs and symptoms generally observed included anemia, chills, fever, anorexia and azotemia. During the course of therapy, renal function tests indicated glomerulotubular dysfunction. A compensated metabolic acidosis was present, and renal biopsies on several patients demonstrated nephrocalcinosis. Amphotericin B is effective in the treatment of disseminated coccidioidomycosis. The drug is nephrotoxic. The presence of nephrocalcinosis indicates that the renal damage may not be completely reversible.