CYP2C19 Genotyping Plus Therapeutic Drug Monitoring Dependent Voriconazole Treatment for Invasive Pulmonary Aspergillosis in a Patient with Liver Failure
Abstract. Invasive pulmonary aspergillosis (IPA) is a lethal infectious disease with high mortality in patients with liver failure. Early recognition of the risk factors prompting earlier diagnosis and treatment may improve the outcomes. Voriconazole is recommended as the first-line drug for IPA, bu...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health - Lippincott Williams Wilkins
2022-04-01
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| Series: | Infectious Diseases & Immunity |
| Online Access: | http://journals.lww.com/10.1097/ID9.0000000000000036 |
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| Summary: | Abstract. Invasive pulmonary aspergillosis (IPA) is a lethal infectious disease with high mortality in patients with liver failure. Early recognition of the risk factors prompting earlier diagnosis and treatment may improve the outcomes. Voriconazole is recommended as the first-line drug for IPA, but hepatotoxicity limits its use in the context of liver diseases. We report a case of a 63-year-old female who was admitted to the Third Affiliated Hospital of Hebei Medical University due to IPA after glucocorticoid therapy for liver failure. The polymorphism of cytochrome P450 (CYP) isoenzymes showed CYP2C19∗1/∗2 genotype associated with intermediate metabolism of voriconazole. However, the patient developed side effects such as skin rash, vomiting, hyperbilirubinemia, and alteration of consciousness, even if she received half of the recommended dosage for voriconazole. Therapeutic drug monitoring (TDM) was applied to guide the dosage adjustment of voriconazole in this patient, and consequently, the patient presented a favorable outcome. In conclusion, genotyping screening plus TDM dependent individualized treatment of voriconazole may improve the survival of liver failure patient with IPA. |
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| ISSN: | 2693-8839 |