Voriconazole-induced phototoxicity masquerading as chronic graft-versus-host disease of the skin in allogeneic hematopoietic cell transplant recipients.
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.
Patel
Asha R
AR
Dermatology Branch, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Turner
Maria L
ML
Baird
Kristin
K
Gea-Banacloche
Juan
J
Mitchell
Sandra
S
Pavletic
Steven Z
SZ
Wise
Barbara
B
Cowen
Edward W
EW
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
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole