Posaconazole achieves prompt recovery of voriconazole-induced liver injury in a case of invasive aspergillosis

• Main Authors: Martínez-Casanova J, Carballo N, Luque S, Sorli L, Grau S
• Format: Article
• Language: English
• Published: Dove Medical Press 2018-03-01
• Series: Infection and Drug Resistance
• Subjects: case report; antifungal agents; hepatotoxicity; therapeutic drug monitoring.
• Online Access: https://www.dovepress.com/posaconazole-achieves-prompt-recovery-of-voriconazole-induced-liver-in-peer-reviewed-article-IDR

Javier Martínez-Casanova,1 Nuria Carballo,1 Sonia Luque,1 Luisa Sorli,2 Santiago Grau1 1Pharmacy Department, Hospital del Mar, Barcelona, Spain; 2Infectious Diseases Department, Hospital del Mar, Barcelona, Spain Abstract: Azole antifungals have frequently been linked to the presence of hepatotoxicity, but there is scarce information on cross-toxicity between these drugs or on the possibility of using some of them when this type of toxicity occurs. We report the case of a 64-year-old man with invasive aspergillosis (IA) leading to spondylodiscitis with neurological involvement. Early management included intravenous (iv) voriconazole, which had to be interrupted after 1 week due to liver damage. Therapeutic drug monitoring (TDM) of voriconazole showed that the plasma concentration was within the therapeutic range. However, it was replaced by a combination therapy of oral posaconazole plus iv caspofungin. Posaconazole allowed normalization of liver enzymes. After finishing posaconazole monotherapy on an outpatient basis, the patient made a full recovery. This case report provides further evidence that oral posaconazole is safe and effective as rescue therapy after the appearance of voriconazole-induced liver toxicity. Keywords: case report, antifungal agents, hepatotoxicity, therapeutic drug monitoring