Voriconazole-refractory invasive aspergillosis
Open Access
- 1 September 2017
- journal article
- case report
- Published by Korean Association of Internal Medicine in The Korean Journal of Internal Medicine
- Vol. 32 (5), 805-812
- https://doi.org/10.3904/kjim.2017.109
Abstract
Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of choice for IA treatment. However, some patients with IA suffer clinical deterioration despite voriconazole therapy. Management of voriconazole-refractory IA remains challenging; no useful recommendations have yet been made. Voriconazole-refractory IA can be further categorized as disease attributable to misdiagnosis or co-infection with another mold; inadequate blood voriconazole blood; inadequate tissue drug concentrations attributable to angioinvasion; immune reconstitution inflammatory syndrome; or infection with voriconazole-resistant Aspergillus. Hence, when encountering a case of voriconazole-refractory IA, it is necessary to schedule sequential tests to decide whether medical treatment or surgical intervention is appropriate; to adjust the voriconazole dose via drug monitoring; to seek CYP2C19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.Keywords
Funding Information
- Korea Health Industry Development Institute
- Ministry of Health and Welfare (HI16C0272)
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