Severe Adverse Reactions Following Ketoconazole, Fluconazole, and Environmental Exposures: A Case Report

Abstract

In this case report, we describe a 66-year-old man who developed multiple adverse reactions beginning at age 56 after exposure to several azole antifungal drugs including ketoconazole and fluconazole. He also had a history of more than 40 years exposure to chemicals including pesticides, wood preservatives, fertilizers, and welding chemicals. His reactions involved dehydration (requiring several liters of intravenous fluids in less than an hour to alleviate this condition), angioedema, nausea, tinnitus, hypotension, and difficulty breathing. His acute adverse reactions were triggered by a wide range of chemicals including gasoline, diesel fuel, pesticides, chlorine, topical isopropyl alcohol, and paper mill emissions. His acute reactions were also triggered by a wide range of foods such as bananas, apples, milk, white potatoes, and processed sweets. A number of mechanisms could be responsible for his increased sensitivity to chemicals following exposure to fluconazole/ketoconazole, including inhibition of P450 and other detoxification enzymes, acetaldehyde buildup, and neurogenic sensitization.

Antifungal Activity of Endophytic Bacteria Isolated from Miana Plants (Coleus scutellarioides (L.) Benth.) against Candida albicans

“…One of the drugs commonly used to overcome fungal infections is ketoconazole. However, ketoconazole is known to have side effects such as pruritus, nausea, rash, abdominal pain, headache, dizziness, fatigue, impotence, menstrual disorders, and gynecomastia (Lieberman & Curtis 2018, Sinawe & Casadesus 2023. Considering these side effects, people are increasingly opting for alternative treatments that incorporate natural ingredients or traditional medicinal practices.…”