Back to Journals » Infection and Drug Resistance » Volume 11

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


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

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

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]