Ventricular Tachycardia: A Rare Side Effect of Voriconazole

Excerpt

To the Editor: An 11-y-old boy being treated for aplastic anemia developed fever with hematuria on 15th day of cyclosporine therapy. Investigations revealed: hemoglobin 7g/dL, total leucocyte count 2300/mm³ and platelet count 20,000/mm³. The child was started on intravenous ceftazidime and amikacin and supportive therapy. However after 48h, his fever persisted and antibiotics were changed to intravenous vancomycin and meropenem. A day later, the child developed extensive oral thrush with palatal ulcerations and amphoterecin B was also started. Three days later, oral lesions improved but the blood urea increased to 65mg/dL. Intravenous amphoterecin B and vancomycin were substituted with intravenous voriconazole and teicoplanin. On 16th day of voriconazole therapy, he complained of transient visual disturbances lasting for about 5 min. The ocular examination was found unremarkable. On 20th day of voriconazole therapy, he developed mild jaundice and investigations revealed serum bilirubin 3mg/dL, serum glutamic pyruvate transaminase 80IU/dL, and serum glutamic ornithine transaminase 76IU/dL. In view of hepatitis, voriconazole therapy was interrupted while intravenous antibiotics were continued. A week later, the liver functions normalized, but fever and oral lesions re-appeared. The child was re-started on intravenous voriconazole. The blood and urine cultures were sterile. Chest radiograph and ultrasonogram of chest were unremarkable. Two days later, the child complained of decreased oral acceptance and dizziness. Examination revealed heart rate (HR) 160/min, respiratory rate (RR) 26/min, and blood pressure 75/50 mmHg. The child was administered intravenous fluid bolus and dopamine infusion was started. Investigations revealed: hemoglobin 6g/dL, total leucocyte count 1100/mm³, platelet count 10,000/mm³, blood urea 49mg/dL, serum sodium 135mEq/L, serum potassium 4.2mEq/L and serum calcium 9mg/dL. Electrocardiogram revealed monomorphic ventricular tachycardia (Fig. 1). In view of hypotension and ventricular tachycardia, direct-current (DC) cardioversion was attempted but the child succumbed.

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