伏立康唑致精神、视觉障碍和肝功能异常1例

One case of mental and visual impairment and abnormal liver function induced by voriconazole

1例56岁男性患者,20余年前体检发现HBsAg阳性,肝功能不详,曾口服拉米夫定抗病毒治疗2年,后自行停药。之后间断服用中成药、中草药等护肝治疗,因腹胀、乏力,为进一步诊治来我院就诊,诊断乙型肝炎肝硬化失代偿期合并腹水、腹膜炎,因肺部真菌感染应用伏立康唑抗真菌治疗,用药12 d后出现肝酶波段性升高,同时出现视弱、畏光、上肢震颤及惊厥。进行血药浓度监测,显示伏立康唑血药浓度12.64 mg·L^(-1),停药3 d后,不良反应消失,伏立康唑血药浓度降至4.96 mg·L^(-1)。

One56-year-old male patient was diagnosed as HBsAg positive in a physical examination20years ago and the liver function was unknown.The patient took lamivudine for antiviral treatment for2years.The patient received intermittent treatment with Chinese patent medicine and herbal medicine in order to protect the liver.The patient was admitted with a complaintof abdominal distension and fatigue,and diagnosed as decompensated hepatitis B cirrhosis with ascites and peritonitis.The patient took voriconazole for pulmonary fungal infection,after12days of treatment,the liver enzyme bands increased,at the same time photophobia,tremor and convulsion occured.Monitoring of blood concentration showed voriconazole concentration of12.64mg·L-1,3days after drug withdrawal,the adverse reactions disappeared,blood concentration reduced to4.96mg·L-1.