Key result
Antifungal agents combined with pro-arrhythmogenic drugs trigger TdP and cardiac arrest, unmasking inherited LQTS.
Case Report (n=1)
Drug-drug interactions involving antifungal agents can trigger life-threatening arrhythmias like torsades de pointes and unmask underlying inherited long QT syndrome.
Supports vigilance for QT interactions with antifungals; leaves open whether genetic screening for long QT syndrome is warranted.
A 14-year-old Tahitian girl with acute myeloid leukaemia and a suspected mucormucosis infection was treated with intravenous voriconazole and caspofungin. Because of worsening of fungal infection, voriconazole was switched to posaconazole. During the switch, the patient presented with QT interval prolongation with 'torsades de pointes' and reversible cardiac arrest. Voriconazole plasma level measured 15 h after the last administration was 7 mg/L. Genotyping suggested that the patient was an extensive metabolizer with respect to CYP2C9 and CYP2C19. The association of antifungal agents with pro-arrhythmogenic drugs and other risk factors led to torsades de pointes and the revealing of inherited QT syndrome.
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Eiden et al. (2007) conducted a case report in Acute myeloid leukaemia, suspected mucormycosis infection, inherited long QT syndrome (n=1). Antifungal agents (voriconazole, caspofungin, posaconazole) was evaluated on QT interval prolongation with torsades de pointes and reversible cardiac arrest. The association of antifungal agents with pro-arrhythmogenic drugs and other risk factors led to torsades de pointes and reversible cardiac arrest, revealing an inherited long QT syndrome.
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