One CYP2C19 Poor Metabolizers Patient with Rash and Xanthopsia Induced by Voriconazole:a Case Report

LIAN Yu-feia; LIU Hong-taoa; CAO Ge-xia; GAO Hai-xiangb; HAN Xiao-wenb

doi:10.3969/j.issn.1002-3429.2017.01.026

Abstract：Objective To investigate the correlation between CYP2C19 genetic polymorphism and adverse drug reac-tion induced by Voriconazole in order to provide references for rational drug use. Methods Clinical data of CYP2C19 poor metabolizers and pulmonary aspergillosis one patient with rash and xanthopsia induced by Voriconazole was retrospectively ana-lyzed. Results The patient was admitted for acute episode of chronic obstructive pulmonary disease. Pulmonary aspergillosis was found by sputum culture,and pulmonary aspergillosis was diagnosed,so the patient was treated with Voriconazole (200 mg,ivgtt,2 times/d,and double dose for first time). Infection symptom was relieved apparently,but a series of symp-toms such as skin rash in both lower extremities,cloudy vision and xanthopsia were found after 3 days of medication. Clinical pharmacists highly suspected that the patient had drug eruptions induced by Voriconazole after excluding organic disease of skin and eyes,and therefore Voriconazole was stopped,and genotype of CYP2C19 was tested for the patient. Xanthopsia was disappeared,and skin rash was relieved on the next day after stopping medication. Gene test showed that CYP2C19*2*3 homozygote mutation( poor metabolizer),so Voriconazole dose was adjusted to 100 mg( ivgtt,2 times/d)subsequently. Pa-tient was discharged after condition improvement by 3 weeks of therapeutics. Conclusion CYP2C19 gene polymorphism is one of important reasons of adverse reactions occurrence induced by Voriconazole,and therefore it can be used to detect Vori-conazole adverse reactions,make individualized treatment plan and provide an objective basis for rational drug use in clinic.