title: Voriconazole-induced blistering in the setting of graft versus host disease: A report of 2 patients.
abstract: Voriconazole is a newer triazole antifungal agent with a wide spectrum of activity against yeast, fungi and molds including many Candida, Aspergillus, and Fusarium species. Its use continues to increase, particularly in immunocompromised patients, owing to its broad coverage, availability in both intravenous and oral preparations, and safety profile. The detection of adverse events in these patients may be complicated by their preexisting comorbidities and polypharmacy. We describe 2 patients with hematologic malignancies status post allogeneic bone marrow transplantation who developed blistering eruptions on the extremities related to voriconazole use. A history of graft versus host disease in each patient confounded and delayed the diagnosis. It is imperative to recognize voriconazole-induced blistering as a separate and distinct entity in such patients with a history of graft versus host disease, since delayed withdrawal of voriconazole use could result in unnecessary and potentially dangerous increases in immunosuppressive therapy.
authors.affiliation: Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. jconlon@springfieldclinic.com
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Conlon
authors.forename: Marie
authors.initials: M
authors.lastname: Dauenhauer
authors.forename: Viseslav
authors.initials: V
authors.lastname: Tonkovic-Capin
authors.forename: Julie
authors.initials: J
authors.lastname: Talano
authors.forename: David
authors.initials: D
authors.lastname: Margolis
authors.forename: Beth A
authors.initials: BA
authors.lastname: Drolet
authors.forename: Janet A
authors.initials: JA
authors.lastname: Fairley
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001768:Blister / Q000139:chemically induced* / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005121:Extremities; D005260:Female; D005670:Fusarium; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole