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

Authors Martínez-Casanova J, Carballo N, Luque S, Sorli L, Grau S

Received 18 October 2017

Accepted for publication 22 December 2017

Published 5 March 2018 Volume 2018:11 Pages 317—321

DOI https://doi.org/10.2147/IDR.S154457

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

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

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