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Cystoid macular edema secondary to fluconazole toxicity

George N Magrath1, Jose S Pulido, Javier Montero

  • 1Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.

Ocular Immunology and Inflammation
|August 26, 2010
PubMed

Insights

High-dose fluconazole, used for fungal infections, may cause retinal toxicity. This case report details a patient who developed vision problems and macular edema, which resolved after dose reduction.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Pharmacology

Background:

  • Fluconazole is a common antifungal for Coccidioides immitis.
  • Known side effects include fatigue, rash, headache, and elevated liver enzymes.
  • Retinal toxicity has not been previously associated with fluconazole.

Observation:

  • A 76-year-old woman with chronic Coccidioides infection received high-dose fluconazole.
  • She experienced fluconazole toxicity symptoms and developed bilateral cystoid macular edema.
  • Her vision improved and edema resolved upon dose reduction and transition to voriconazole.

Findings:

  • This case suggests a potential link between high-dose, prolonged fluconazole use and retinal toxicity.
  • Cystoid macular edema may be a presenting sign of fluconazole-induced ocular toxicity.
  • Prompt management by dose adjustment and antifungal switch can lead to visual recovery.

Implications:

  • Clinicians should consider retinal toxicity in patients on high-dose fluconazole presenting with visual disturbances.
  • Further research is warranted to understand the mechanism and incidence of fluconazole-related retinal toxicity.
  • This case highlights the importance of monitoring for ocular side effects with prolonged antifungal therapy.

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