Cutaneous phototoxic reaction to intravenous micafungin in the outpatient setting: A case report

Abstract

• Micafungin can be used for the management of azole-resistant CMC in STAT1-GoF. • Micafungin was identified as the probable cause of a phototoxic skin reaction. • More research on phototoxicity of micafungin and its metabolites is required. • Clinicians should remain aware of the potential for phototoxic reactions. Signal Transducer and Activator of Transcription 1 (STAT1) Gain of Function (GoF) mutations can predispose to chronic mucocutaneous candidiasis (CMC). Long term therapy with oral azole antifungals can result in resistance and the need to treat with alternatives such as echinocandins. A pan-azole-resistant Candida albicans was isolated from a mouth swab from a 39-year-old woman with lifelong CMC. Her condition warranted systemic treatment and this was achieved through daily infusions of micafungin, which the patient self-administered at home within the OPAT (Outpatient Parenteral Antimicrobial Therapy) service. The patient experienced a good and rapid clinical response. On day 18 of treatment the patient developed an itchy rash and presented back to our hospital on day 22. A diagnosis of phototoxic skin reaction, secondary to micafungin, was established through clinical history, signs, and investigations. Micafungin was withdrawn and the phototoxic reaction resolved without further intervention. The patient was maintained on amphotericin oral lozenges. More research into the phototoxic potential of micafungin and its metabolites is needed but clinicians should remain aware of the potential of phototoxicity in individuals treated in outpatient and OPAT settings.