Results
Over the five-year period, seven cases fulfilled the inclusion criteria.
The median age was 7.3 years (range 4.2-16.6) and 6/7 were male (Table
1). Four had a hematological malignancy, two had a primary
immunodeficiency and five were hematopoietic stem cell transplant
recipients (HSCT) (Table 1). The most common azole switch was
voriconazole to fluconazole (3/7), followed by fluconazole to
voriconazole (2/7). One child each switched from voriconazole to
itraconazole, and posaconazole to fluconazole.
Of the seven cases, five had Grade 3 liver injury and two had Grade 2
liver injury. All children had an elevated Gamma-glutamyl Transferase
(GGT) level (Grade 2 to 3) and three had Grade 2 Alanine
Aminotransferase (ALT) abnormalities (Table 1; Figure 1). These LFT
abnormalities were deemed as ‘possibly’ in four cases, and ‘probably’ in
three cases to be related to the first azole antifungal as per the
Naranjo criteria 6. All had improvement in their LFT
abnormalities after the switch to an alternative azole antifungal,
however, in only two patients, did the LFTs normalise by the end of
treatment (Case 3 and 4, Table 1). The most common concomitant
medications include acetaminophen in all cases,
penicillin/beta-lactamase inhibitors in 5 cases, antiemetics in 4 cases
and chemotherapeutics in 3 cases (Table 1).