Liposomal Amphotericin B-Induced Distal Renal Tubular Acidosis in a Patient with T-ALL and Febrile Neutropenia: A Diagnostic Challenge

We report a rare case of distal renal tubular acidosis (dRTA) induced by liposomal amphotericin B (Ambisome) in a 29-year-old female with relapsed T-cell acute lymphoblastic leukemia (T-ALL), admitted for febrile neutropenia and opportunistic infections. Despite clinical stability under multiple broad-spectrum antimicrobials, serial arterial blood gases revealed persistent non-anion gap hyperchloremic metabolic acidosis, hypokalemia, and preserved renal function. The acidosis developed shortly after Ambisome initiation and resolved following its discontinuation, suggesting a causal relationship. This case emphasizes the importance of considering tubular toxicity even with liposomal amphotericin B and maintaining vigilance for dRTA in immunocompromised patients.