Voriconazole-Induced Hepatotoxicity Presenting With Severe Hepatic Encephalopathy After Liver Transplantation

Abstract

Voriconazole-induced hepatotoxicity is a relatively rare but serious clinicopathologic entity. This drug is frequently used for invasive aspergillosis and other fungal infections. We report a patient with alcoholic cirrhosis who developed hepatic encephalopathy due to voriconazole administered for invasive pulmonary aspergillosis and subsequently showed marked improvement in mental status with dose adjustment of the drug. The patient eventually underwent an uneventful liver transplant. Histopathologic examination of the diseased liver specimen revealed numerous rhomboid-shaped crystals, deemed secondary to liver injury after voriconazole-induced hepatotoxicity. Additionally, this article briefly reviews the available data on voriconazole-induced hepatotoxicity with special emphasis on plasma drug concentration monitoring.

Voriconazole-Induced Cholestatic Hepatotoxicity in an Immune Competent Patient

“…Immunocompromised patients are prone to have fungal or disseminated fungal infections and are managed with anti-fungal medications like voriconazole. It is important to monitor any complications of anti-fungal therapy [ 7 , 8 ].…”

Hepatotoxicity of Antibiotics and Antifungals and Their Safe Use in Hepatic Impairment

“…209 Hepatic encephalopathy due to voriconazole DILI in a patient with underlying cirrhosis has been described as well. 240 Immunoallergic features are rare but can occur. 241 Hepatic impairment studies have been conducted for voriconazole.…”