Peripheral eosinophilia and eosinophilic colitis during long-term azole therapy for pulmonary aspergillosis

Area of Science:

• Medical Mycology
• Clinical Pharmacology
• Gastroenterology

Background:

• Voriconazole and posaconazole are key treatments for invasive Aspergillus infections.
• Chronic pulmonary aspergillosis (CPA) management often involves long-term azole antifungal therapy.
• Adverse effects of these antifungals require careful monitoring.

Purpose of the Study:

• To report a case of eosinophilic colitis and peripheral eosinophilia associated with voriconazole and posaconazole therapy.
• To highlight potential adverse effects of long-term azole antifungal use in CPA patients.
• To inform clinical practice regarding monitoring for these specific side effects.

Main Methods:

• A case report of a 75-year-old female patient with CPA.
• Detailed description of treatment with oral voriconazole followed by posaconazole.
• Documentation of adverse events including peripheral eosinophilia, diarrhea, and eosinophilic colitis.

Main Results:

• The patient developed peripheral eosinophilia and eosinophilic colitis after >5 years of voriconazole.
• Symptoms resolved upon discontinuation of azole therapy.
• Recurrent eosinophilia and diarrhea occurred during subsequent posaconazole treatment.

Conclusions:

• Long-term voriconazole and posaconazole can successfully manage CPA exacerbations.
• These azole antifungals are associated with potential adverse effects like peripheral eosinophilia, diarrhea, and eosinophilic colitis.
• Clinicians should be vigilant for these side effects during prolonged antifungal treatment.