Share This Article:

Treatment of pulmonary coccidioidomycosis after successful hepatitis C therapy in a patient with fluconazole induced hepatotoxicity

Abstract Full-Text HTML XML Download Download as PDF (Size:1026KB) PP. 22-27
DOI: 10.4236/ojgas.2012.21005    3,774 Downloads   6,776 Views  


A patient with hepatitis C infection and cavitary pul- monary coccidioidomycosis is reported. Treatment of hepatitis C was associated with resolution of flucona- zole-induced hepatotoxicity. Successful treatment of he- patitis C enabled the patient to tolerate increaseing doses of fluconazole. This case highlights that hepatic toxicity of fluconazole can improve after successful treatment of hepatitis C.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Movahedi, Z. , Wisinger, D. , Petre, S. , Ravi, J. , Ardiles, T. , Prevette, R. , Al-Yaqoobi, A. and Nadir, A. (2012) Treatment of pulmonary coccidioidomycosis after successful hepatitis C therapy in a patient with fluconazole induced hepatotoxicity. Open Journal of Gastroenterology, 2, 22-27. doi: 10.4236/ojgas.2012.21005.


[1] Ampel, N.M. (2010) New perspectives on coccidioidomycosis. Proceedings of the American Thoracic Socirty, 7,181-185. doi:10.1513/pats.200907-080AL
[2] Ampel, N.M. (2010) Coccidioidomycosis: A review of recent advances. Clinics in Chest Medicine, 30, 241-251. doi:10.1016/j.ccm.2009.02.004
[3] Grant, S.M. and Clissold, S.P. (1990) Fluconazole: A re- view of its pharmacodynamic and pharmacokinetic pro- perties,and therapeutic potential in superficial and sys- temic mycoses. Drugs, 39, 877-916. doi:10.2165/00003495-199039060-00006
[4] Silling, G. (2002) Fluconazole: Optimized antifungal the- rapy based on pharmacokinetics. Mycoses, 45, 39-41. doi:10.1111/j.1439-0507.2002.tb04768.x
[5] Song, J.C. and Deresinski S. (2005) Hepatotoxicity of an- tifungal agents. Current Opinion in Investigational Drugs, 6, 170-177.
[6] Gearhart, M.O. (1994) Worsening of liver func-tion with fluconazole and review of azole antifungal hepato-toxicity. The Annuals of Pharmacotherapy, 28, 1177-1181.
[7] Wells, C. and Lever, A.M. (1992) Dose-dependent flu- conazole hepatotoxicity proven on biopsy and rechallenge. Journal of Infection, 24, 111-112. doi:10.1016/0163-4453(92)91346-D
[8] Kim, H. and Bindslev-Jensen, C. (2004) Reported case of severe hepatotox-icity likely due to fluconazole and not desloratadine. Acta Haematologica, 112, 177-178. doi:10.1159/000079733
[9] Girois, S.B., Chapuis, F., Decul-lier, E. and Revol, B.G. (2005) Adverse effects of antifungal therapies in invasive fungal infections: Review and meta-analysis. European Journal of Clinical Microbiology & Infectious Disease, 24, 119-130. doi:10.1007/s10096-005-1281-2
[10] Wang, J.L., Chang, C.H., Young-Xu, Y. and Chan, K.A. (2010) Systematic review and meta-analysis of the toler- ability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection. Antim- icrobial Agents and Chemotherapy, 54, 2409-2419. doi:10.1128/AAC.01657-09
[11] Rex, J.H., Pappas, P.G. and Karchmer, A.W. (2003) A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus ampho- tericin B as therapy for candidemia and its conse-quences in nonneutropenic subjects. Clinical Infectious Diseases, 36, 1221-1228.
[12] Joly, V., Bolard, J. and Yeni, P. (1992) In vitro models for studying toxicity of antifungal agents. Antimicrobial Agents and Chemotherapy, 36, 1799-1804.
[13] Somchit, N., Hassim, S.M. and Samsudin, S.H. (2002) Itra- conazole- and fluconazole-induced toxicity in rat hepato- cytes: A comparative in vitro study. Human & Experi- mental Toxicology, 21, 43-48. doi:10.1191/0960327102ht208oa
[14] Rodriguez, R.J. and Acosta Jr., D. (1995) Comparison of ketoconazole- and fluco-nazole-induced hepatotoxicity in a primary culture system of rat hepatocytes. Toxicology, 96, 83-92. doi:10.1016/0300-483X(94)02911-D
[15] Rodriguez, R.J. and Acosta Jr., D. (1996) Inhibition of mitochondrial function in isolated rate liver mitochondria by azole antifungals. Journal of Biochemical Toxicology, 11, 127-131. doi:10.1002/(SICI)1522-7146(1996)11:3<127::AID-JBT4>3.0.CO;2-M
[16] Somchit, N., Ngee, C.S., Yaakob, A., Ahmad, Z. and Za- karia, Z.A. (2009) Effects of cytochrome p450 inhibitors on itraconazole and fluconazole induced cytotoxicity in hepatocytes. Journal of Toxicology, Article ID: 912320. doi:10.1155/2009/912320
[17] Somchit, N., Norshahida, A.R., Hasiah, A.H., Zuraini, A., Sulaiman, M.R. and Noordin, M.M. (2004) Hepatotoxicity induced by antifungal drugs itraconazole and fluco- nazole in rats: A comparative in vivo study. Human & Experimental Toxicology, 23, 519-525. doi:10.1191/0960327104ht479oa
[18] Sun, G., Thai, S.F. and Lambert, G.R. (2006) Flucona- zole-induced hepatic cytochrome P450 gene expression and enzymatic activities in rats and mice. Toxicology Let- tes, 164, 44-53. doi:10.1016/j.toxlet.2005.11.015
[19] Guillaume, M.P., De Prez, C. and Cogan, E. (1996) Sub- acute mitochondrial liver disease in a patient with AIDS: Possible relationship to pro-longed fluconazole administration. The American Journal of Gastroenterology, 91, 165-168.
[20] Labarga, P., Soriano, V. and Vispo, M.E. (2007) Hepato- toxicity of antiretroviral drugs is reduced after successful treatment of chronic hepatitis C in HIV-infected patients. The Journal of Infectious Diseases, 196, 670-676. doi:10.1086/520092
[21] Aranzabal, L., Casado, J.L. and Moya, J. (2005) Influence of liver fibrosis on highly active antiretroviral therapy-associated hepatotoxicity in patients with HIV and hepatitis C virus coinfection. Clinical Infectious Disesses, 40, 588-593. doi:10.1086/427216
[22] Uberti-Foppa, C., De Bona, A. and Morsica, G., (2003) Pretreatment of chronic active hepatitis C in patients co- infected with HIV and hepatitis C virus reduces the he- patotoxicity associated with subsequent antiretroviral therapy. Journal of Acquired Immune Deficiency Syn- dromes, 33, 146-152. doi:10.1097/00126334-200306010-00005
[23] Sulkowski, M.S. and Benhamou, Y. (2007) Therapeutic issues in HIV/HCV-coinfected patients. Journal of Viral Hepatitis, 14, 371-386. doi:10.1111/j.1365-2893.2006.00816.x
[24] Sulkowski, M.S. (2004) Drug-induced liver injury asso- ciated with antiretroviral therapy that includes HIV-1 pro- tease inhibitors. Clinical Infectious Disesses, 38, S90- S97. doi:10.1086/381444
[25] Flaman, A.S., Gravel, C., Hashem, A.M., Tocchi, M. and Li, X. (2011) The effect of interfe-ron-alpha on the expression of cytochrome P450 3A4 in human hepatoma cells. Toxicology and Applied Pharmacology, 253, 130- 136. doi:10.1016/j.taap.2011.03.019
[26] Tanner, A.R. and Powell, L.W. (1979) Corticosteroids in liver disease: Poss-ible mechanisms of action, pharmacology, and rational use. Gut, 20, 1109-1124. doi:10.1136/gut.20.12.1109

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.