[Case of pulmonary aspergillosis associated with inappropriate antidiuretic hormone syndrome caused by voriconazole therapy].
A 75-year-old man presented with hemoptysis. Consolidation was identified in the left lower lobe around multiple bullae. He was found to have chronic necrotizing pulmonary aspergillosis based on a high titer of aspergillus antigen and positive antibody. He was treated with 400 mg/day voriconazole. However, liver dysfunction and hyponatremia developed at 21 days after beginning administration of voriconazole. Serum sodium levels were 122 mEq/l. but urinary sodium showed a high level of 135 mEq/l. The serum sodium level improved 10 days after voriconazole was discontinued. Serum levels of voriconazole on day 15 were high at 18 microg/ml (safe effective serum level: 1.5 to 4.5 microg/ml). An analysis of genetic polymorphism showed a mutation of cytochrome P450 (CYP2C19*2 G681A). We report the first case of a voriconazole-induced syndrome of inappropriate antidiuretic hormone caused by a polymorphism mutation of cytochrome P450.
Isobe
Kazutoshi
K
Department of Respiratory Medicine. Toho University Omori Medical Center.
Muraoka
Sei
S
Sugino
Keishi
K
Yamazaki
Yoko
Y
Kikuchi
Naoshi
N
Hamanaka
Nobuyuki
N
Takai
Yujiro
Y
Shimizu
Kunihiko
K
Kimura
Kazuhiro
K
Hiroi
Naoki
N
Shibuya
Kazutoshi
K
Homma
Sakae
S
D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy*; D002908:Chronic Disease; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000209:etiology*; D011110:Polymorphism, Genetic; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D003577:Cytochrome P-450 Enzyme System; D065819:Voriconazole