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Article in Japanese
A case of pulmonary aspergillosis associated with inappropriate antidiuretic hormone syndrome caused by voriconazole therapy
Kazutoshi Isobe1) Sei Muraoka1) Keishi Sugino1) Yoko Yamazaki1) Naoshi Kikuchi1) Nobuyuki Hamanaka1) Yujiro Takai1) Kunihiko Shimizu1) Kazuhiro Kimura1) Naoki Hiroi3) Kazutoshi Shibuya2) Sakae Homma1)
1)Department of Respiratory Medicine 2)Department of Pathology 3)Department of Diabetes, Metabolism and Endocrinology Medicine, Toho University Omori Medical Center
A 75-year-old man presented with hemoptysis. Consolidation was identified in the left lower lobe around multiple bullae. He was found to have chronic necrotizing pulmonary aspergillosis based on a high titer of aspergillus antigen and positive antibody. He was treated with 400 mg/day voriconazole. However, liver dysfunction and hyponatremia developed at 21 days after beginning administration of voriconazole. Serum sodium levels were 122 mEq/l. but urinary sodium showed a high level of 135 mEq/l. The serum sodium level improved 10 days after voriconazole was discontinued. Serum levels of voriconazole on day 15 were high at 18 μg/ml (safe effective serum level: 1.5 to 4.5 μg/ml). An analysis of genetic polymorphism showed a mutation of cytochrome P450 (CYP2C19*2G681A). We report the first case of a voriconazole-induced syndrome of inappropriate antidiuretic hormone caused by a polymorphism mutation of cytochrome P450.
Pulmonary aspergillosis Chronic necrotizing pulmonary aspergillosis Voriconazole Syndrome of inappropriate antidiuretic hormone Genetic polymorphism
Received 平成18年11月8日
JJRS, 45(6): 489-493, 2007