イトラコナゾールとウベニメクスの併用投与により偽性アルドステロン症を来した1例

Abstract

We report a case of pseudoaldosteronism caused by combination treatment with itraconazole (Itrizol) and ubenimex (Bestatin). A 53-year-old female with acute myelocytic leukemia developed multiple liver abscess due to Aspergillus infection during courses of chemotherapy despite achieving a complete remission. She was treated with intravenous administration of miconazole (Florid-F), and then with oral administration of itraconazole. Marked reduction of the liver abscess was observed by the antifungal treatment without any side effects. One hundred eight days after the initiation of itracon- azole administration, she was given ubenimex for maintenance therapy of leukemia. On the 6th day after the addition of ubenimex, she suddenly complained of numbness of the extremities, polyuria and muscular weakness. She was diagnosed as having pseudoaldoster- onism by laboratory findings such as markedly decreased levels of serum potassium, plasma renin activity and plasma aldosterone. All the symptoms and abnormalities in laboratory findings disappeared within 25 days only by the discontinuance of ubenimex and itracon- azole. This is the first reported case of pseudoaldosteronism caused by combination treatment with itraconazole and ubenimex. Deep mycosis is commonly associated with immuno- suppresive situations such as leukemia. It is, therefore, supposed that there is a relatively high possibility of the simultaneous administration of itraconazole and ubenimex. The case reported here, however, gives notice that the development of pseudoaldosteronism needs to be taken into consideration in patients treated with a combination of itraconazole and ubenimex.