Voriconazole-induced musical hallucinations

Area of Science:

• Pharmacology
• Neurology
• Mycology

Background:

• Voriconazole (Vfend) is a widely used second-generation azole antifungal.
• It is prescribed for invasive aspergillosis and febrile neutropenia.
• Voriconazole typically has a mild side effect profile, with visual disturbances being most common.

Observation:

• A case study of a 78-year-old man undergoing chemotherapy for acute myelogenous leukemia (AML).
• The patient developed auditory hallucinations, specifically hearing Christmas music, on the second day of voriconazole therapy.
• Psychiatric evaluation revealed no other significant findings.

Findings:

• Discontinuation of voriconazole led to a decrease in hallucination intensity by day two and complete cessation by day three.
• A comprehensive literature search, including drug trial data, found no previous reports of auditory hallucinations associated with voriconazole.
• Musical hallucinations are often linked to temporal lobe issues and can have religious or patriotic themes.

Implications:

• This case highlights a rare potential side effect of voriconazole, specifically musical auditory hallucinations.
• It suggests that clinicians should consider voriconazole as a potential cause of musical hallucinations in patients.
• Further research may be warranted to understand the neurobiological mechanisms underlying this rare adverse drug reaction.