Intractable Nausea in a Heart Transplant Patient

Area of Science:

• Medical Case Study
• Clinical Toxicology
• Pharmacology

Background:

• A 59-year-old woman with a history of breast cancer treated with anthracyclines and subsequent non-ischemic cardiomyopathy requiring heart transplant.
• Recently diagnosed with a cavitary lung nodule and initiated on voriconazole therapy.

Observation:

• Patient presented with persistent nausea and abdominal pain.
• Initial workup revealed cholelithiasis, leading to a cholecystectomy, but symptoms continued.
• Further investigation identified elevated voriconazole levels as the likely cause of her gastrointestinal distress.

Findings:

• Discontinuation of voriconazole led to the complete resolution of the patient's nausea and abdominal pain.
• This case suggests a correlation between elevated voriconazole levels and gastrointestinal adverse effects.

Implications:

• Highlights the importance of therapeutic drug monitoring for voriconazole, especially in patients with complex medical histories.
• Underscores the need to consider drug toxicity in the differential diagnosis of persistent gastrointestinal symptoms.
• Informs clinical practice regarding potential side effects of voriconazole in immunocompromised patients or those with altered drug metabolism.