Case Report: Dual toxicity of voriconazole in a CYP2C19 poor metabolizer: a case analysis of life-threatening neutropenia and hepatocellular injury. (PubMed, Front Pharmacol) - Sep 6, 2026 - "Following discontinuation of voriconazole, antifungal therapy was sequentially changed to isavuconazonium sulfate, nebulized amphotericin B liposome, and intravenous amphotericin B cholesteryl sulfate complex, together with granulocyte colony-stimulating factor and hepatoprotective therapy. This case illustrates a clinical scenario in which pre-emptive pharmacogenomic testing, vigilant monitoring of complete blood counts alongside liver function, and integration with therapeutic drug monitoring (TDM) may enhance safety in patients requiring long-term voriconazole therapy. The absence of TDM data precludes definitive confirmation of voriconazole overexposure; nevertheless, the convergence of CYP2C19 PM genotype, temporal relationship, dechallenge, and structured causality assessment renders presumed drug accumulation the most plausible explanation for the observed toxicities while not excluding all competing contributors."
Journal • Hematological Disorders • Hepatology • Liver Failure • Neutropenia • Pulmonary Disease • Respiratory Diseases • CYP2C19
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