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Frequent premature ventricular contractions induced by fluconazole: A case report

Kumi Tamura1, Kazuhiko Nakaharai1, Masaki Yoshida1

  • 1Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Japan.

Idcases
|April 25, 2024
PubMed
Abstract

Insights

Fluconazole can cause frequent premature ventricular contractions (PVCs), a mild arrhythmia. This case suggests a dose-dependent relationship, highlighting the need for careful cardiac monitoring during antifungal treatment.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Fluconazole is a widely used antifungal agent for Candida and Cryptococcus infections.
  • Fatal arrhythmias like torsades de pointes have been reported with fluconazole.
  • Mild, non-fatal arrhythmias associated with fluconazole may be underreported.

Observation:

  • A 47-year-old HIV-positive patient developed frequent unifocal premature ventricular contractions (PVCs) during treatment for pulmonary cryptococcosis with fluconazole.
  • The PVCs were attributed to fluconazole, originating from the right ventricular outflow tract without QT prolongation.
  • Symptoms and PVC frequency decreased upon dose reduction and resolved after fluconazole discontinuation.

Findings:

  • This case report details fluconazole-induced frequent PVCs in a patient with HIV-related pulmonary cryptococcosis.
  • Evidence suggests a potential dose-dependent relationship between fluconazole and PVC occurrence.
  • Complete resolution of PVCs was observed after discontinuing the antifungal medication.

Implications:

  • Clinicians should be vigilant for non-fatal arrhythmias, such as PVCs, during fluconazole therapy.
  • Electrocardiogram (ECG) monitoring before and after fluconazole administration is crucial for early detection of cardiac events.
  • This case underscores the importance of considering drug-induced arrhythmias in patients presenting with irregular heartbeats.
Keywords:
Adverse eventAntifungalArrhythmiaFluconazolePremature ventricular contractions

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