title: 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 a broad spectrum of coverage against fungal species and is frequently utilized in the post-HCT setting. Herein, we describe 5 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.
authors.affiliation: Dermatology Branch, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Asha R
authors.initials: AR
authors.lastname: Patel
authors.forename: Maria L
authors.initials: ML
authors.lastname: Turner
authors.forename: Kristin
authors.initials: K
authors.lastname: Baird
authors.forename: Juan
authors.initials: J
authors.lastname: Gea-Banacloche
authors.forename: Sandra
authors.initials: S
authors.lastname: Mitchell
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
authors.forename: Barbara
authors.initials: B
authors.lastname: Wise
authors.forename: Edward W
authors.initials: EW
authors.lastname: Cowen
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D017484:Dermatitis, Phototoxic / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006086:Graft vs Host Disease / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole