Phototoxicity, Pseudoporphyria, and Photo-onycholysis Due to Voriconazole in a Pediatric Patient With Leukemia and Invasive Aspergillosis.
Voriconazole is a triazole antifungal agent superior to amphotericin B in the treatment of invasive aspergillosis. It is generally well tolerated and has excellent oral bioavailability, providing significant benefit in the treatment of invasive fungal infections. There have been numerous reports of dermatologic reactions to this agent, including erythroderma, cheilitis, Stevens-Johnson syndrome, discoid lupus erythematosus, pseudoporphyria, squamous cell carcinoma, and photosensitivity reactions. Pseudoporphyria, a dermatologic condition mimicking porphyria cutanea tarda, has been described as an adverse effect of voriconazole use. Clinical findings include photosensitivity, vesicles, bullae, milia, and scarring in sun-exposed areas. Photo-onycholysis is a phenomenon of nail discoloration and onycholysis that has been described in the setting of a phototoxic drug reaction and pseudoporphyria. Implicated drugs have most commonly been tetracyclines, fluoroquinolones, and psoralens; others have been reported as well. We report a case of a pediatric patient with leukemia who developed symptoms consistent with pseudoporphyria and later photo-onycholysis while being treated with voriconazole. To our knowledge, this is the first reported case of pseudoporphyria due to voriconazole in a pediatric patient and the first reported case of photo-onycholysis as a consequence of voriconazole use.
['Willis|Zachary I|ZI|', 'Boyd|Alan S|AS|', 'Di Pentima|M Cecilia|MC|']
D000842:Ankle D001228:Aspergillosis D001768:Blister D055499:Catheter-Related Infections D000077723:Cefepime D002511:Cephalosporins D002613:Cheilitis D002648:Child D002921:Cicatrix D002981:Clindamycin D017484:Dermatitis, Phototoxic D054714:Echinocandins D006801:Humans D007008:Hypokalemia D016867:Immunocompromised Host D064704:Levofloxacin D055666:Lipopeptides D008275:Magnesium Deficiency D008297:Male D000077551:Micafungin D054039:Onycholysis D010787:Photosensitivity Disorders D011164:Porphyrias D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma D014640:Vancomycin D065819:Voriconazole
phototoxicity pseudoporphyria photo-onycholysis voriconazole