Voriconazole-Induced acute interstitial pulmonary edema with angioedema: A case report

BACKGROUND: Voriconazole is a first-line antifungal agent for invasive fungal infections. Reports of voriconazole-induced interstitial pulmonary edema are exceedingly rare. CASE PRESENTATION: We describe a 74-year-old woman with pneumonia who developed facial edema, dyspnea, and pink frothy sputum after four days of voriconazole therapy. Chest computed tomography (CT) revealed bilateral pleural effusions and interlobular septal thickening. She was initially misdiagnosed with acute heart failure, but failed to respond to diuretics. Both B-type natriuretic peptide (BNP) levels and echocardiography were unremarkable. The diagnosis of voriconazole-induced acute interstitial pulmonary edema was established. Voriconazole withdrawal and corticosteroid therapy resulted in rapid clinical resolution. CONCLUSION: Voriconazole hypersensitivity may manifest as acute interstitial pulmonary edema with concomitant angioedema, a presentation that can mimic cardiogenic pulmonary edema. Early recognition and timely corticosteroid intervention are crucial for favorable outcomes.