Azole-Induced Myositis after Combined Lung-Liver Transplantation

Abstract

Lung transplant recipients experience a high rate of invasive pulmonary aspergillosis infections, for which voriconazole is the treatment of choice. We report a patient who developed voriconazole-induced myositis that relapsed after one dose of isavuconazole. Our patient was a 38-year-old man who received a single sequential lung transplantation and liver transplantation because of end-stage cystic fibrosis. He presented to our emergency room with acute pain in both forearms at 3 weeks after voriconazole was initiated for invasive pulmonary aspergillosis infection. Levels of voriconazole were normal during the course of therapy. After stopping voriconazole, the symptoms decreased but relapsed after one dose of isavuconazole. Other causes of muscle pain and inflammation were excluded. Magnetic resonance imaging of both arms showed muscle edema in both arms, including involvement of the fascia, consistent with myositis. There were no signs of necrosis. Isavuconazole was discontinued, and the corticosteroid dose was temporarily increased, with rapid resolution of all complaints. Our patient is the fourth reported case of voriconazole-induced myositis, and the first whose symptoms relapsed after initiating isavuconazole.

Isavuconazole for Treating Invasive Mould Disease in Solid Organ Transplant Recipients

“…We identified 20 studies which included at least one SOT recipient who received isavuconazole as treatment for an IMD (Figure 1). Overall, 13 studies met the inclusion criteria, including one prospective observational study which described 53 SOT recipients treated with isavuconazole for fungal infections [15], one multicenter retrospective study with 81 SOT recipients with proven or probable IMD treated with isavuconazole for ≥24 h as first-line or salvage therapy [16], and eleven case reports [17][18][19][20][21][22][23][24][25][26][27]. One case report was not included as it lacked most data related to the transplantation and six studies were excluded as they included both SOT and patients with hematologic malignancies and stem cell transplantation.…”