Successful Treatment of Post-tuberculosis Pulmonary Aspergillosis With Liposomal Amphotericin B in a Patient After a Rare Event of Voriconazole-Associated Hypotension: A Case Report

TL;DR

A patient with post-tuberculosis aspergillosis experienced hypotension from voriconazole and was successfully treated with liposomal amphotericin B.

Contribution

Reports a rare case of voriconazole-induced hypotension and successful alternative treatment with LAmB in post-TB aspergillosis.

Findings

Voriconazole caused hypotension in an immunocompetent patient with post-TB aspergillosis.

Switching to LAmB resolved symptoms and stabilized blood pressure without adverse effects.

LAmB is a viable alternative when voriconazole is intolerable or other azoles are unavailable.

Abstract

Pulmonary aspergillosis (PA) is a serious lung infection caused by Aspergillus species, primarily affecting individuals with structural lung abnormalities. Common risk factors include pulmonary tuberculosis (TB) and other chronic lung diseases. Voriconazole, a second-generation triazole, is the preferred first-line treatment for invasive PA, although few adverse events are reported. Liposomal amphotericin B (LAmB) serves as an alternative treatment, particularly in cases of azole resistance or intolerance. This case report describes a rare occurrence of probable voriconazole-associated hypotension in a 52-year-old immunocompetent male with post-TB aspergillosis. The patient, previously treated for TB, presented with pleuritic chest pain, productive cough, and hemoptysis. Initial treatment with voriconazole led to significant symptomatic relief but was complicated by persistent hypotension, despite normal blood parameters. A multidisciplinary team identified voriconazole as the cause of hypotension, and treatment was switched to LAmB. Consequently, his blood pressure stabilized, and the PA symptoms resolved without any adverse events. This case underscores the importance of monitoring rare side effects during voriconazole therapy and highlights LAmB as an alternative in voriconazole-intolerant scenarios and in situations where the availability of other azoles (posaconazole and itraconazole) is limited; however, further research is necessary to optimize therapeutic strategies.

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