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Voriconazole-associated peripheral polyneuropathy: A case report.

Bárbara J González1, Paula Ivarola1, Miguel Miranda1

  • 1Neurology Department, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Autonomous City of Buenos Aires, Argentina.

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Summary

Voriconazole, an antifungal, can cause peripheral neuropathy in immunocompromised patients. This neurotoxicity resolved after stopping the drug, highlighting its importance in differential diagnosis.

Keywords:
drug-related side effects and adverse reactionspolyneuropathytoxicityvoriconazole

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Area of Science:

  • Medical Mycology
  • Clinical Neurology
  • Pharmacology

Background:

  • Invasive fungal infections, particularly aspergillosis, pose a significant threat to immunocompromised individuals.
  • Azole antifungals, such as voriconazole, are standard treatments for these infections.
  • Voriconazole use has been associated with adverse events, including peripheral neuropathy.

Observation:

  • Two cases of immunocompromised patients (acute myeloblastic leukemia and primary immunodeficiency) developed peripheral sensory motor axonal polyneuropathy.
  • These neurological symptoms emerged during voriconazole treatment.
  • The polyneuropathy completely resolved after voriconazole was discontinued.

Findings:

  • Voriconazole can induce peripheral sensory motor axonal polyneuropathy in vulnerable patient populations.
  • The neurotoxic effect of voriconazole appears to be reversible upon drug cessation.
  • This adverse event warrants consideration in the differential diagnosis of neurological symptoms in patients receiving voriconazole.

Implications:

  • Clinicians should consider voriconazole-induced neurotoxicity when evaluating peripheral neuropathy in immunocompromised patients.
  • Early recognition and discontinuation of voriconazole may lead to complete recovery from polyneuropathy.
  • This finding is particularly relevant for pediatric patients receiving multiple medications, where differentiating drug-induced effects is crucial.