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KMID : 1144320110430050421
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감염과 화학요법
2011 Volume.43 No. 5 p.421 ~ p.424
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A Case of Visual and Auditory Hallucinations during Intravenous Voriconazole Therapy
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Kim Min-Ju
Youn Moon-Hee
Kim Sang-Bae
Cho Yul-Hee
Lee Min-Young
Cho Sung-Yeon
Kwon Jae-Cheol
Kim Si-Hyun
Kim Yoo-Jin
Lee Dong-Gun
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Abstract
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Voriconazole is a triazole with broad spectrum antifungal activity, and it is currently considered to be the first-line agent for the treatment of invasive aspergillosis. We report here on a case of visual and auditory hallucinations during intravenous treatment with voriconazole in association with a high trough level. A 28-year-old man with acute myelogenous leukemia was admitted for re-induction remission chemotherapy. During the persistent neutropenic fever, intravenous voriconazole was administered for the suspected invasive fungal pneumonia. He began to have visual hallucinations on the 1st day and auditory hallucinations on the 3rd day of voriconazole therapy. The plasma peak and trough concentration levels of voriconazole were 9.9 and 7.4 μg/ml, respectively, on the 3rd day. The hallucinations resolved after changing to amphotericin B deoxycholate, and the plasma concentration of voriconazole dropped to less than 0.5 μg/ml. The genotype of the CYP2C19 alleles was classified as a heterozygous extensive metabolizer. We suggest that therapeutic drug monitoring of voriconazole is indicated for a case that is suspicious for a voriconazole-related adverse event.
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KEYWORD
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Voriconazole, Hallucinations, Drug Monitoring, Therapeutic
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