title: Phototoxicity, Pseudoporphyria, and Photo-onycholysis Due to Voriconazole in a Pediatric Patient With Leukemia and Invasive Aspergillosis.
abstract: Voriconazole is a triazole antifungal agent superior to amphotericin B in the treatment of invasive aspergillosis. It is generally well tolerated and has excellent oral bioavailability, providing significant benefit in the treatment of invasive fungal infections. There have been numerous reports of dermatologic reactions to this agent, including erythroderma, cheilitis, Stevens-Johnson syndrome, discoid lupus erythematosus, pseudoporphyria, squamous cell carcinoma, and photosensitivity reactions. Pseudoporphyria, a dermatologic condition mimicking porphyria cutanea tarda, has been described as an adverse effect of voriconazole use. Clinical findings include photosensitivity, vesicles, bullae, milia, and scarring in sun-exposed areas. Photo-onycholysis is a phenomenon of nail discoloration and onycholysis that has been described in the setting of a phototoxic drug reaction and pseudoporphyria. Implicated drugs have most commonly been tetracyclines, fluoroquinolones, and psoralens; others have been reported as well. We report a case of a pediatric patient with leukemia who developed symptoms consistent with pseudoporphyria and later photo-onycholysis while being treated with voriconazole. To our knowledge, this is the first reported case of pseudoporphyria due to voriconazole in a pediatric patient and the first reported case of photo-onycholysis as a consequence of voriconazole use.
authors.affiliation: Infectious Diseases Division, Department of Pediatrics.
authors.forename: Zachary I
authors.initials: ZI
authors.lastname: Willis
authors.affiliation: Department of Medicine, Division of Dermatology; Department of Pathology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Boyd
authors.affiliation: Infectious Diseases Division, Department of Pediatrics.
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Di Pentima
mesh_terms: D000842:Ankle / Q000473:pathology; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D001768:Blister / Q000139:chemically induced / Q000473:pathology; D055499:Catheter-Related Infections; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D002613:Cheilitis / Q000139:chemically induced; D002648:Child; D002921:Cicatrix / Q000139:chemically induced; D002981:Clindamycin / Q000627:therapeutic use; D017484:Dermatitis, Phototoxic / Q000150:complications; D054714:Echinocandins / Q000627:therapeutic use; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D016867:Immunocompromised Host / Q000187:drug effects*; D064704:Levofloxacin / Q000627:therapeutic use; D055666:Lipopeptides / Q000627:therapeutic use; D008275:Magnesium Deficiency / Q000139:chemically induced; D008297:Male; D000077551:Micafungin; D054039:Onycholysis / Q000139:chemically induced*; D010787:Photosensitivity Disorders / Q000139:chemically induced*; D011164:Porphyrias / Q000139:chemically induced*; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy; D014640:Vancomycin / Q000627:therapeutic use; D065819:Voriconazole / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002511:Cephalosporins; D054714:Echinocandins; D055666:Lipopeptides; D002981:Clindamycin; D064704:Levofloxacin; D014640:Vancomycin; D000077723:Cefepime; D065819:Voriconazole; D000077551:Micafungin
keywords: photo-onycholysis; phototoxicity; pseudoporphyria; voriconazole