Abstract
Voriconazole is a frequently prescribed anti-fungal medication used in particular for invasive aspergillosis. Voriconazole-induced hepatotoxicity is a relatively rare but serious clinicopathologic entity. We report a patient presenting with impaired liver function test results pointing towards the cholestatic picture. The patient had initial blood tests to confirm cholestasis, followed by imaging modalities that did not show any obstruction along the common bile duct and/or pancreatic pathway. The patient’s voriconazole dose reduction was advised, resulting in lower levels of abnormal liver function tests.
Highlights
Voriconazole is a clinical challenge for patients with invasive aspergillosis, as the drug level varies between each patient towards therapeutic index
The patient was deemed medically stable and discharged back to the nursing home, with an advice to the general practitioner (GP) for a periodic fortnightly blood liver function tests to ensure a downtrend towards normalization
The most recent case reports published in 2011, 2013, 2014, 2015, and 2019 that mentioned cholestatic liver function test results with voriconazole use reported these findings in immunocompromised patients [5,6]
Summary
Voriconazole is a clinical challenge for patients with invasive aspergillosis, as the drug level varies between each patient towards therapeutic index. Serum markers Serum Bilirubin (total) Serum Alkaline Phosphatase (ALP) Serum Alanine Transaminase (ALT) Serum Voriconazole level Serum Albumin units umol/L U/L U/L mg/L g/L He was found to be on high-dose voriconazole treatment with no history of being immune compromised, and no history of chronic liver disease. The patient was deemed medically stable and discharged back to the nursing home, with an advice to the general practitioner (GP) for a periodic fortnightly blood liver function tests to ensure a downtrend towards normalization He was reviewed six months later in an out-patient gastroenterology clinic with normalization of the blood liver function tests
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