Kitaya Shiori, Nakano Makoto, Katori Yukio, Yasuda Satoshi, Kanamori Hajime
Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.
Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
Microorganisms. 2024 Aug 8;12(8):1619. doi: 10.3390/microorganisms12081619.
QTc prolongation and torsade de pointes (TdP) are significant adverse events linked to azole antifungals. Reports on QTc interval prolongation caused by these agents are limited. In this study, we report a case of a 77-year-old male with cardiovascular disease who experienced QTc prolongation and subsequent TdP while being treated with fluconazole for -induced knee arthritis. Additionally, a literature review was conducted on cases where QTc prolongation and TdP were triggered as adverse events of azole antifungal drugs. The case study detailed the patient's experience, whereas the literature review analyzed cases from May 1997 to February 2023, focusing on patient demographics, underlying diseases, antifungal regimens, concurrent medications, QTc changes, and outcomes. The review identified 16 cases, mainly in younger individuals (median age of 29) and women (75%). Fluconazole (63%) and voriconazole (37%) were the most common agents. Concurrent medications were present in 75% of cases, and TdP occurred in 81%. Management typically involved discontinuing or switching antifungals and correcting electrolytes, with all patients surviving. Risk assessment and concurrent medication review are essential before starting azole therapy. High-risk patients require careful electrocardiogram monitoring to prevent arrhythmias. Remote monitoring may enhance safety for patients with implanted devices. Further studies are needed to understand risk factors and management strategies.
QTc间期延长和尖端扭转型室速（TdP）是与唑类抗真菌药相关的严重不良事件。关于这些药物导致QTc间期延长的报道有限。在本研究中，我们报告了一例77岁患有心血管疾病的男性，在因氟康唑治疗诱发的膝关节炎期间出现QTc间期延长及随后的TdP。此外，还对因唑类抗真菌药物的不良事件引发QTc间期延长和TdP的病例进行了文献综述。病例研究详细描述了患者的经历，而文献综述分析了1997年5月至2023年2月的病例，重点关注患者人口统计学、基础疾病、抗真菌治疗方案、同时使用的药物、QTc变化及结局。该综述确定了16例病例，主要为年轻个体（中位年龄29岁）和女性（75%）。氟康唑（63%）和伏立康唑（37%）是最常见的药物。75%的病例同时使用了其他药物，81%发生了TdP。治疗通常包括停用或更换抗真菌药物并纠正电解质，所有患者均存活。在开始唑类治疗前，风险评估和同时使用药物的审查至关重要。高危患者需要仔细进行心电图监测以预防心律失常。远程监测可能会提高植入设备患者的安全性。需要进一步研究以了解危险因素和管理策略。
