Voriconazole-induced Myositis in a Double Lung Transplant Recipient

Soliman, Mohanad; Akanbi, Olalekan; Harding, Cameron; El-Helw, Mohamed; Anstead, Michael

doi:10.7759/cureus.3998

Cited by 5 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Less frequently reported are an increase in cutaneous malignancies (especially in patients on immunosuppressive therapy), cardiac arrhythmias by QT prolongation or electrolyte disturbances, peripheral neuropathy, periostitis (most commonly in ulna and ribs), alopecia, nail changes [ 2 ], and myositis. Voriconazole-induced myositis has only been described in three case reports to date [ 3 – 5 ], and one of those cases was also a double lung transplant recipient with a history of CF [ 4 ], overview in Table 3 .…”

Section: Discussionmentioning

confidence: 99%

Azole-Induced Myositis after Combined Lung-Liver Transplantation

Happaerts

Wieërs

Mijnsbrugge³

et al. 2022

Case Reports in Transplantation

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Azole-Induced Myositis after Combined Lung-Liver Transplantation

Happaerts

Wieërs

Mijnsbrugge³

et al. 2022

Case Reports in Transplantation

View full text Add to dashboard Cite

show abstract

“…Azole antifungal agent-induced myotoxicity has been previously reported, and most cases are associated with concomitant statin use because of the supression of drug metabolism [5][6][7]. However, as a member of azole antifungal agent, voriconazole has been rarely reported to have independent myotoxic effects [2,3]. Up to now, the detailed mechanism of voriconazole-induced myotoxicity remains largely unknown.…”

Section: Discussionmentioning

confidence: 99%

“…The common adverse effects of voriconazole include hepatotoxicity, visual disturbances, photosensitivity, fever, nausea, vomiting, and rash [1]. However, voriconazole-associated myotoxicity is rarely reported [2,3], and can be easily overlooked by clinicians. The delayed treatment of myotoxicity is potentially lethal, resulting in rhabdomyolysis and even acute renal failure.…”

Section: Introductionmentioning

confidence: 99%

Muscle toxicity induced by intravenous voriconazole in a cryptogenic organizing pneumonia patient misdiagnosed as suspected pulmonary fungal infection

Wang

Zhou

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Although voriconazole is a widely used azole antifungal agent in clinical practice, its side effect of muscle toxicity is extremely rare. The present study demonstrates an adverse effect of progressive myotoxicity induced by intravenous voriconazole in a cryptogenic organizing pneumonia patient misdiagnosed as suspected pulmonary fungal infection.Case presentation A 78-year-old male was admitted to our hospital due to recurrent cough and expectoration for four months. His previous chest CT scan indicated alveolar opacities and multiple cavitary nodules in the right lower lobe. Pulmonary fungal infection was considered due to weakly positive results of serum galactomannan and 1,3 β-D-glucan test,with no evidence of malignant tumor, tuberculosis, or Wegener's granulomatosis. The patient experienced diffuse myalgia with significantly elevated muscle enzymes after voriconazole administration for 13 days, and recovered uneventfully due to immediate voriconazole cessation and enhanced intravenous fluid infusion. Furthermore, the pulmonary cavitary nodules were consistent with the pathological findings of cryptogenic organizing pneumonia.Conclusions Voriconazole-associated myotoxicity should be considered when a patient presents with evidence of muscle injury during voriconazole administration. Morever, although invasive pulmonary fungal infection can often show multiple nodules with cavities in CT scan, the initiation of anti-fungal agents should be cautious before the pathological features of multiple cavitary nodules are identified, in order to avoid potential serious adverse events.

show abstract

Drug-Induced Myopathies

Jain

2021

Drug-Induced Neurological Disorders

View full text Add to dashboard Cite

Voriconazole-induced Myositis in a Double Lung Transplant Recipient

Cited by 5 publications

References 13 publications

Azole-Induced Myositis after Combined Lung-Liver Transplantation

Azole-Induced Myositis after Combined Lung-Liver Transplantation

Muscle toxicity induced by intravenous voriconazole in a cryptogenic organizing pneumonia patient misdiagnosed as suspected pulmonary fungal infection

Drug-Induced Myopathies

Contact Info

Product

Resources

About