Liver Necrosis in a Patient Receiving Isavuconazole: Making the Case for Therapeutic Drug Monitoring
Abstract
An 81-year-old man prescribed isavuconazole for pulmonary fungal infection developed high serum transaminase levels and biopsy-confirmed hepatic necrosis associated with prolonged high serum isavuconazole levels. Genotyping revealed poor CYP3A5 activity/normal CYP3A4 activity. Older age and slow isavuconazole elimination likely led to isavuconazole-associated hepatic toxicity. This case underscores the importance of isavuconazole therapeutic drug monitoring.
Fields of Study & Subjects
Antifungal resistance and susceptibility
Drug-Induced Hepatotoxicity and Protection
Pneumocystis jirovecii pneumonia detection and treatment
Publication details
- Journal / source
- Open Forum Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Volume
- 13
- Issue
- 3
- Pages
- ofag090–ofag090
- Publication date
- 25 February 2026
- Language
- EN