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Potential voriconazole associated posterior reversible leukoencephalopathy in children with malignancies: Report of

Ali Amanati1, Mehrzad Lotfi2, Rob Van Manen3

  • 1Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|July 22, 2020
PubMed
Abstract

Insights

Voriconazole, an antifungal, can cause posterior reversible encephalopathy syndrome (PRES) even at prescribed doses. Promptly stopping voriconazole upon suspecting neurotoxicity improves patient outcomes.

Area of Science:

  • Neuroscience
  • Pharmacology
  • Infectious Diseases

Background:

  • Fungal infections pose significant morbidity in cancer patients.
  • Voriconazole is a first-line triazole antifungal for invasive fungal infections.

Observation:

  • Two cases of posterior reversible encephalopathy syndrome (PRES) following voriconazole exposure are presented.
  • Neuroimaging and serum voriconazole levels were analyzed to evaluate toxicity.
  • Methotrexate's role in PRES was diminished through detailed MRI analysis.

Findings:

  • Voriconazole can induce PRES, a serious neurological condition, even at therapeutic concentrations.
  • Prompt discontinuation of voriconazole is crucial for managing voriconazole-induced PRES.
  • Early clinical suspicion and intervention lead to favorable patient prognosis.

Implications:

  • PRES should be considered in patients on voriconazole presenting with neurotoxicity.
  • This highlights the importance of monitoring for adverse neurological effects of voriconazole.
  • Clinicians should be aware of the potential for voriconazole-induced PRES at therapeutic levels.
Keywords:
Voriconazoleinvasive fungal infectionsmalignancyposterior reversible encephalopathy syndrome

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