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Clinical Features - Case report

Acute fluconazole toxicity: a case presenting with protean manifestations including systemic and neurologic symptoms

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Pages 250-252 | Received 05 Jun 2020, Accepted 20 Oct 2020, Published online: 12 Nov 2020
 

ABSTRACT

Neurologic adverse effects of triazole antifungal compounds used for the treatment of systemic and deep mycoses are relatively rare. The most common presentation is the involvement of peripheral nervous system, usually presenting with subjective symptoms such as paresthesia, dysesthesia, or numbness. Among these compounds, fluconazole has relatively more frequent neurological adverse reactions.

A 54-year-old man was admitted with numbness and weakness in his both feet, which gradually worsened and resulted in difficulty in ambulation over time. He had no morbidity other than hypertension. He developed polyneuropathy (PNP), lower gastrointestinal system bleeding, acute renal insufficiency, thrombotic thrombocytopenic purpura, and confusional state. Severely disabling axonal and demyelinating sensorimotor PNP which led to immobilization of the patient for a few weeks but was recovered. When a more detailed past medical history was taken, he admitted to ingestion of 200 mg/day fluconazole for 1 month for onychomycosis without any prescription. This unusual combination of these rare adverse reactions of fluconazole may be explained by activation of an immune mechanism triggered by the drugs and genetic factors, or some other unknown individual factors.

This case is reported due to the presence of rare systemic and neurologic adverse events of fluconazole, leading to this unusual clinical picture. We would like to emphasize fluconazole-related systemic and neurologic adverse reactions with life-threatening potential should be kept in mind.

Acknowledgments

None stated

Declaration of funding

No funding was received in the production of this manuscript.

Declaration of financial/other relationships

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Declaration of interest

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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