Voriconazole-associated peripheral polyneuropathy: A case report

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.