[A suspected case of voriconazole-induced lung injury].
A 71-year-old man was initially given a diagnosis of pulmonary nontuberculous mycobacterial infection due to Mycobacterium intracellulare (M. intracellulare). The patient was admitted because chest roentgenogram and CT scanning showed a progression of infiltrating shadows in the bilateral upper lung fields. Aspergillus fumigatus was identified by bronchial lavage. The patient was found to have chronic necrotizing pulmonary aspergillosis with M. intracellulare and treated with voriconazole (VRCZ). After fifteen days of treatment, he complained of dyspnea and cough. A chest CT showed new diffuse ground glass opacity in the left lower lobe. Arterial blood gas analysis demonstrated severe hypoxemia. Due to concerns about drug-induced lung injury, voriconazole was discontinued and corticosteroid therapy was started. VRCZ was replaced by micafungin. Thereafter, symptoms and left lower shadows resolved. Although the lymphocyte stimulation test for voriconazole was negative, we considered that this pulmonary lesion may have been an adverse reaction to voriconazole.
Department of Pulmonary Medicine, National Hospital Organization Matsue Hospital.
Shigenori
S
Ishikawa
Shuichi
S
Yano
Yoshiyuki
Y
Tokuda
Kiryo
K
Wakabayashi
Kanako
K
Kobayashi
Toshikazu
T
Ikeda
Hiroyasu
H
Takeyama
D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects*; D001228:Aspergillosis / Q000188:drug therapy; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced*; D008172:Lung Diseases, Fungal / Q000188:drug therapy; D008297:Male; D011743:Pyrimidines / Q000009:adverse effects*; D014230:Triazoles / Q000009:adverse effects*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole