Significance of monitoring plasma concentration of voriconazole in a patient with liver failure: A case report

Rationale: Rationale:Invasive pulmonary aspergillosis is associated with significant morbidity and mortality in patients with liver failure. Voriconazole (VRCZ) is recommended as a primary therapeutic agent for the treatment of invasive aspergillosis and metabolized in the liver. Now, data are still lacking on the safety and appropriate dosage of VRCZ in patients with liver failure. Here, we report a representative case of invasive pulmonary fungal infection in a patient with liver failure who was treated with low-dose VRCZ. Patient concerns: Patient concerns:A 21-year-old man, presented with subacute liver failure caused suspected by viral infection, was admitted on June 22, 2014. Liver function was not improved by the treatment of gancicolovir and methylprednisolone. The patient presented with fever, cough, and hyperpyrexia on July 14. Laboratory tests revealed raised neutrophil percentage (82.1%, normal range [NR] 50–70), international normalized ratio (INR) (2.32, NR 0.8–1.2) and levels of serum lactic acid (4.308 mmol/L, NR 0.6–2.2), alanine transaminase (165 U/L,NR 0–40), aspartate transaminase (99 U/L, NR 8–40), and total bilirubin (654 mmol/L, NR 3.4–20.5). Furthermore, CD4+ T cell, CD8+T cell, and B cell count were low (169, 221, and l8/mL, respectively). Sputum smear microscopy for bacteria was negative, but the direct observation for fungal elements was positive. Thoracic CT scan revealed bilateral pulmonary high-density shadow. Sputum cultures...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research