Voriconazole-Associated Phototoxicity

Voriconazole is an extended-spectrum triazole antifungal approved for treatment of invasive fungal infections. The drug has been associated with phototoxicity, presenting as photodistributed eruptions such as macular erythema or pseudoporphyria. We describe a 59-year-old man with acute myeloid leukemia, status-post matched unrelated donor stem cell transplant, who developed fungal pneumonia and was placed on posaconazole. The patient had difficulty complying with the four-times daily dosing and was switched to voriconazole 200 mg twice daily. Soon after, the patient began working outside and subsequently developed photodistributed, macular erythema of the head, neck, and upper chest. Melanoma and squamous cell carcinoma have developed in patients with chronic treatment with voriconazole. Strict adherence to photoprotective measures can prevent the side effect of phototoxic eruption or prevent recurrence in patients who develop this adverse reaction without having to discontinue voriconazole.