The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Voriconazole-refractory invasive aspergillosis

  • Park, Se Yoon (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Jung-A (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.01.13
  • Accepted : 2017.08.06
  • Published : 2017.09.01
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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

Acknowledgement

Supported by : Korea Health Industry Development Institute (KHIDI)

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