Late-onset isavuconazole-induced liver injury

Area of Science:

• Medical Mycology
• Hepatology
• Pharmacology

Background:

• Antifungal agents are implicated in approximately 3% of Drug-Induced Liver Injury (DILI) cases.
• Isavuconazole, a novel triazole antifungal, has limited data regarding long-term safety and potential hepatotoxicity.
• Chronic pulmonary aspergillosis requires prolonged antifungal treatment, increasing the risk of adverse events.

Observation:

• A 55-year-old man of Angolan descent developed late-onset DILI after 11 months of isavuconazole therapy.
• The patient was undergoing long-term treatment for chronic pulmonary aspergillosis secondary to treated pulmonary tuberculosis.
• Liver injury was idiosyncratic, not correlated with elevated isavuconazole serum concentrations.

Findings:

• Isavuconazole therapy was associated with the development of DILI.
• Discontinuation of isavuconazole led to normalization of liver function tests.
• The case suggests a potential for idiosyncratic, late-onset hepatotoxicity with prolonged isavuconazole use.

Implications:

• Clinicians should consider monitoring liver function in patients on long-term isavuconazole, especially those with underlying conditions.
• This case adds to the understanding of isavuconazole's safety profile in extended use scenarios.
• Further research is warranted to elucidate the mechanisms and incidence of isavuconazole-induced liver injury.