Voriconazole and posaconazole are often used to treat invasive infections. We describe a patient with chronic pulmonary aspergillosis (CPA) who experienced peripheral eosinophilia and eosinophilic colitis while on voriconazole, and also experienced gastrointestinal symptoms and recurrent eosinophilia while on subsequent posaconazole therapy.

Case presentation:

A 75‐year‐old female with recurrent pulmonary mucus plugs due to CPA was treated with long‐term oral voriconazole. The patient had no clinical evidence of CPA exacerbations while on such antifungal treatment but developed peripheral eosinophilia, diarrhoea and eosinophilic colitis after >5 years of voriconazole therapy that resolved after cessation of azole therapy. Due to a CPA exacerbation after stopping voriconazole, the patient was started on posaconazole as an alternative CPA therapy. However, after 15 months, the patient developed a recurrence of peripheral eosinophilia and diarrhoea while on posaconazole.


Long‐term use of voriconazole and posaconazole can be used successfully to reduce the incidence of CPA exacerbations. However, such antifungal therapy may also lead to peripheral eosinophilia, diarrhoea and eosinophilic colitis.


Article metrics loading...

Loading full text...

Full text loading...



  1. Al‐shair K., Atherton G.T., Harris C., Ratcliffe L., Newton P.J., Denning D.W.. ( 2013;). Long‐term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis57:828–835[CrossRef]
    [Google Scholar]
  2. Kousha M., Tadi R., Soubani A.O.. ( 2011;). Pulmonary aspergillosis: a clinical review. Eur Respir Rev20:156–174[CrossRef]
    [Google Scholar]
  3. Lestner J., Hope W.W.. ( 2013;). Itraconazole: an update on pharmacology and clinical use for treatment of invasive and allergic fungal infections. Expert Opin Drug Metab Toxicol9:911–926[CrossRef]
    [Google Scholar]
  4. Nagappan V., Deresinski S.. ( 2007;). Posaconazole: a broad‐spectrum triazole antifungal agent. Clin Infect Dis45:1610–1617[CrossRef]
    [Google Scholar]
  5. Naranjo C.A., Busto U., Sellers E.M., Sandor P., Ruiz I., Roberts E.A., Janecek E., Domecq C., Greenblatt D.J.. ( 1981;). A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther30:239–245[CrossRef]
    [Google Scholar]
  6. Sambatakou H., Dupont B., Lode H., Denning D.W.. ( 2006;). Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med119:17–24[CrossRef]
    [Google Scholar]
  7. Saravolatz L.D., Johnson L.B., Kauffman C.A.. ( 2003;). Voriconazole: a new triazole antifungal agent. Clin Infect Dis36:630–637[CrossRef]
    [Google Scholar]
  8. Vishnubhotla P., Ibrahim R.B., Abidi M.H., Chandrasekar P.H.. ( 2004;). Fever and eosinophilia associated with voriconazole. Ann Pharmacother38:900–901[CrossRef]
    [Google Scholar]

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error