Voriconazole-Induced Phototoxicity Masquerading as Chronic Graft-versus-Host Disease of the Skin in Allogeneic Hematopoietic Cell Transplant Recipients

Abstract

Systemic fungal infections pose a significant risk to patients following allogeneic hematopoietic cell transplantation (alloHCT). Voriconazole (Vfend®, Pfizer) is an oral second-generation triazole antifungal agent that offers broad spectrum of coverage against fungal species and is frequently utilized in the post-HCT setting. Herein, we describe five patients who were initially believed to be experiencing a flare of cutaneous chronic graft-versus-host disease (cGvHD), but who were actually exhibiting phototoxicity caused by voriconazole. A high index of suspicion for this adverse reaction in the post-alloHCT setting will prevent misdiagnosis and avoid inappropriate therapy for cGvHD.

Fungal infections in oncology patients: update on epidemiology, prevention, and treatment

“…Finally, one recent series of five cases demonstrates the importance of voriconazole phototoxicities and their variable presentation [30]. In this series, multiple patients were 'misdiagnosed' with chronic cutaneous graft versus host disease, but instead had evidence of voriconazole induced phototoxicities.…”

Voriconazole-induced Phototoxicity in Children

“…15 Our results demonstrate that phototoxic skin reactions [2][3][4][5][7][8][9][12][13][14] (see Table, Supplemental Digital Content 4, http://links.lww.com/INF/B156). The data generated in the present case series of 7 patients indicate that voriconazole-induced phototoxic skin reactions in children are common.…”

“…1 Adverse skin reactions related to voriconazole treatment include erythema, cheilitis, urticaria, Stevens-Johnson syndrome, discoid lupus erythematodes, erythema multiforme, pseudoporphyria, squamous cell carcinoma, melanoma, phototoxicity and photosensitivity reactions. [2][3][4][5][6][7][8][9][10][11][12][13][14] We describe an unusually high incidence of voriconazoleassociated phototoxicity affecting 7 of 21 immunocompromised children who received voriconazole as antifungal prophylaxis due to major hospital renovation work during intensive chemotherapy phases between February 2007 and April 2008.…”

Photosensitivity reactions and skin tumours associated with voriconazole

“…15 Three cases of voriconazole-induced photosensitivity occurred in immunocompromised children: a 1-month-old boy, a 3-year-old boy, and a 16-year-old girl. 16 Erythematous lesions, some vesicular, appeared on the face and other sunexposed areas.…”