1887

Abstract

Posaconazole is a triazole antifungal that is used in the treatment of a variety of fungal infections, as well as in the management of mucormycosis (on an off-label basis). Eosinophilia associated with exposure to azole antifungals has been described rarely in the literature.

A 31-year-old male on peritoneal dialysis (PD) for end-stage renal disease, secondary to diabetic nephropathy, presented to hospital with abdominal pain after a trip to St Lucia. He was taken to the operating room, where the PD catheter was removed and an abdominal-wall abscess was debrided. species was recovered on culture of the abdominal-wall tissue, and the patient was started on amphotericin B deoxycholate. He was subsequently stepped down to posaconazole, for a planned treatment duration of 12 months. Approximately 43 days after the initiation of posaconazole, it was noted that his peripheral eosinophil count started to rise. No other cause for the eosinophilia was identified. Posaconazole was discontinued, and the patient’s eosinophil count began to drop 2 days later. The temporal association of eosinophilia following initiation of posaconazole and the subsequent improvement after drug discontinuation suggests a probable causal relationship.

At the time of writing, there have been only two other published cases of azole-associated peripheral eosinophilia. In reporting this case, we hope to increase health-care provider awareness of this rare adverse event. For patients receiving prolonged therapy with posaconazole, periodic monitoring of the complete blood count with differential may be considered.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005100
2017-06-08
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/4/6/jmmcr005100.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005100&mimeType=html&fmt=ahah

References

  1. Torres HA, Hachem RY, Chemaly RF, Kontoyiannis DP, Raad II. Posaconazole: a broad-spectrum triazole antifungal. Lancet Infect Dis 2005; 5:775–785 [View Article][PubMed]
    [Google Scholar]
  2. Merck Noxafil Prescribing Information Whitehouse Station, NJ: Merck; 2014 https://www.merck.com/product/usa/pi_circulars/n/noxafil/noxafil_pi.pdf accessed February 27, 2017
    [Google Scholar]
  3. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K. European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group European Confederation of Medical Mycology et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014; 20 Suppl 3:5–26 [View Article][PubMed]
    [Google Scholar]
  4. Riley TT, Muzny CA, Swiatlo E, Legendre DP. Breaking the mold: a review of mucormycosis and current pharmacological treatment options. Ann Pharmacother 2016; 50:747–757 [View Article][PubMed]
    [Google Scholar]
  5. Tacke D, Koehler P, Markiefka B, Cornely OA. Our 2014 approach to mucormycosis. Mycoses 2014; 57:519–524 [View Article][PubMed]
    [Google Scholar]
  6. Vishnubhotla P, Ibrahim RB, Abidi MH, Chandrasekar PH. Fever and eosinophilia associated with voriconazole. Ann Pharmacother 2004; 38:900–901 [View Article][PubMed]
    [Google Scholar]
  7. Grzegorczyk B, Murata Y. Peripheral eosinophilia and eosinophilic colitis during long‐term azole therapy for pulmonary aspergillosis. JMM Case Rep 2014; 1:10.1099/jmmcr.0.004135 [View Article]
    [Google Scholar]
  8. Mckeage K. Posaconazole: a review of the gastro-resistant tablet and intravenous solution in invasive fungal infections. Drugs 2015; 75:397–406 [View Article][PubMed]
    [Google Scholar]
  9. Garcia-Hermoso D, Alanio A, Lortholary O, Dromer F, Landry ML et al. Agents of systemic and subcutaneous mucormycosis and entomophthoromycosis. In Jorgensen JH, Pfaller MA, Carroll KC, Funke G. (editors) Manual of Clinical Microbiology, 11th ed. Washington, DC: ASM Press; 2015 pp. 2087–2108 [CrossRef]
    [Google Scholar]
  10. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am 2016; 30:143–163 [View Article][PubMed]
    [Google Scholar]
  11. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41:634–653 [View Article][PubMed]
    [Google Scholar]
  12. Rathi M, Sengupta U, Yadav TD, Kumar S. Zygomycetes peritonitis in ambulatory peritoneal dialysis: case report and review of the literature. Indian J Nephrol 2014; 24:252–254 [View Article][PubMed]
    [Google Scholar]
  13. Falagas ME, Karageorgopoulos DE, Tansarli GS. Continuous versus conventional infusion of amphotericin B deoxycholate: a meta-analysis. PLoS One 2013; 8:e77075 [View Article][PubMed]
    [Google Scholar]
  14. Vehreschild JJ, Birtel A, Vehreschild MJ, Liss B, Farowski F et al. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol 2013; 39:310–324 [View Article][PubMed]
    [Google Scholar]
  15. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007; 356:348–359 [View Article][PubMed]
    [Google Scholar]
  16. Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 2007; 356:335–347 [View Article][PubMed]
    [Google Scholar]
  17. Vazquez JA, Skiest DJ, Nieto L, Northland R, Sanne I et al. A multicenter randomized trial evaluating posaconazole versus fluconazole for the treatment of oropharyngeal candidiasis in subjects with HIV/AIDS. Clin Infect Dis 2006; 42:1179–1186 [View Article][PubMed]
    [Google Scholar]
  18. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30:239–245 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005100
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005100
Loading

Data & Media loading...

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