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Chronic cavitary pulmonary histoplasmosis treated with isavuconazole after a hypersensitivity reaction to

Miguel E Cervera-Hernandez1, Sunit P Jariwala2

  • 1Infectious Diseases, Sanford University of South Dakota Medical Center, Sioux Falls, 57105, South Dakota, USA.

Medical Mycology Case Reports
|June 30, 2025
PubMed

Insights

Chronic cavitary pulmonary histoplasmosis treatment can be challenging due to itraconazole hypersensitivity. Isavuconazole offers a promising alternative therapy for patients experiencing adverse reactions to itraconazole.

Area of Science:

  • Mycology
  • Pulmonology
  • Infectious Diseases

Background:

  • Chronic cavitary pulmonary histoplasmosis (CCPH) necessitates long-term antifungal treatment, typically with itraconazole.
  • Hypersensitivity reactions to itraconazole, while uncommon, present a significant clinical challenge in managing CCPH.
  • Limited data exists on the efficacy and cross-reactivity of newer azole antifungals in CCPH patients with itraconazole intolerance.

Observation:

  • A patient with CCPH developed a hypersensitivity reaction to itraconazole, precluding its continued use.
  • Alternative azole antifungal therapy was considered due to the need for sustained treatment of CCPH.

Findings:

  • The patient was successfully treated with isavuconazole after experiencing an itraconazole-induced hypersensitivity reaction.
  • This case demonstrates the successful use of isavuconazole in a patient with CCPH who could not tolerate itraconazole.

Implications:

  • Isavuconazole represents a viable and effective alternative treatment option for CCPH in patients with itraconazole hypersensitivity.
  • Further research into the role of newer azoles like isavuconazole in managing complex fungal infections is warranted.
  • This case contributes to the understanding of azole cross-reactivity and treatment strategies for refractory or intolerant histoplasmosis cases.
Keywords:
Cross-reactionHistoplasmosisHypersensitivityIsavuconazoleItraconazole

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