Generalized exfoliative skin rash as an early predictor of supratherapeutic voriconazole trough levels in a leukemic child: A case report
| Autor: | Majid Yavarian, Parisa Badiee, Ali Amanati, Mohammad Ali Faghihi, Ahmad Monabati, Nazafarin Hatami Mazinani, Mehrzad Lotfi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Side effect QH301-705.5 Erythroderma Case Report Acute lymphoblastic leukemia Therapeutic drug monitoring Microbiology chemistry.chemical_compound Therapeutic index Medicine Biology (General) Internal medicine Voriconazole Skin rash medicine.diagnostic_test business.industry medicine.disease Rash Dermatology RC31-1245 Infectious Diseases chemistry Toxicity medicine.symptom Caspofungin business medicine.drug |
| Zdroj: | Current Medical Mycology Current Medical Mycology, Vol 6, Iss 3, Pp 73-78 (2020) |
| ISSN: | 2423-3420 2423-3439 |
| Popis: | Background and Purpose: Skin rashes, mostly seen in children and adolescents, are considered among the most common side effects of azole antifungals. Although therapeutic concentrations of voriconazole (VCZ) have been documented for infected skin, there is no evidence specifying whether specific dermatologic side effects could predict high VCZ serum concentration, especially in high-risk leukemic children.Case report: Herein, we report a unique skin side effect of VCZ in a 5-year-old boy with T-cell acute lymphoblastic leukemia (ALL) referred to Amir Medical Oncology Center in Shiraz, Iran. The patient experienced erythroderma and macular rashes shortly after VCZ consumption, leading to generalized exfoliative skin rashes. Concurrent to these skin manifestations, VCZ serum concentration reached the supratherapeutic levels despite the recommended VCZ doses. As a result, VCZ was withheld, and the patient was treated with caspofungin. The lesions were resolved gradually within 2 weeks, and the patient successfully completed his treatment course with caspofungin. Conclusion: The unique case presented in this study emphasizes the need for a high index of suspicion for VCZ toxicity in any patient with atypical dermatologic manifestations, especially generalized exfoliative skin rashes. Based on this report, VCZ supratherapeutic concentration could be predicted early in the course of treatment. Additional therapeutic dose monitoring should be considered to establish a confirmatory diagnosis. It is required to further investigate the toxic effect of high VCZ concentration on the skin epithelium. |
| Databáze: | OpenAIRE |
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