Fluconazole-Related Hepatotoxicity in Patients With Acquired Immunodeficiency Syndrome

To the Editor.— Fluconazole is a new triazole that has been successfully used in the treatment of candidal and cryptococcal infections in patients with the acquired immunodeficiency syndrome (AIDS) and in other immunosuppressed patients.1,2In addition to its other advantages, it is considered to be less hepatotoxic than previous imidazole agents.3In fact, no severe adverse effects have been described in previous reports. We have recently performed an open trial of fluconazole therapy in oropharyngeal candidiasis in 27 immunosuppressed patients. We describe three patients (11%) who developed significant hepatotoxicity related to fluconazole therapy (Table). Report of Cases.—Case 1.— A 28-year-old man, with a previous diagnosis of AIDS (disseminated tuberculosis, central nervous system toxoplasmosis) was admitted to the hospital withPneumocystis cariniipneumonia. Treatment with cotrimoxazole was begun. The patient was already receiving isoniazid, rifampin, pyrimethamine, clindamycin, and phenobarbital. On admission, alanine aminotransferase, aspartate aminotransferase, and alkaline