Chronic cavitary pulmonary histoplasmosis treated with isavuconazole after a hypersensitivity reaction to itraconazole
- Author: mycolabadmin
- 6/7/2025
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Summary
A 68-year-old patient with a serious lung infection caused by Histoplasma fungus initially developed an allergic skin reaction to the standard medication itraconazole. Unable to use the typical treatment, doctors switched him to a newer antifungal drug called isavuconazole using a carefully controlled graded dose approach. The patient successfully tolerated the new medication and achieved complete resolution of his infection with sustained improvement, suggesting isavuconazole could be a viable alternative for similar patients.
Background
Chronic cavitary pulmonary histoplasmosis (CCPH) is a serious infection caused by Histoplasma capsulatum that typically requires prolonged treatment with itraconazole. However, hypersensitivity reactions to itraconazole, though rare, present clinical challenges due to limited data on alternative azole efficacy and cross-reactivity.
Objective
To present a case of CCPH successfully treated with isavuconazole following an itraconazole-induced hypersensitivity reaction and to highlight isavuconazole as a potential alternative therapy in such cases.
Results
The patient tolerated the isavuconazole challenge without adverse reactions and continued full-dose therapy for 20 months with clinical and radiographic improvement. Follow-up for 12 months after discontinuation showed no evidence of histoplasmosis recurrence, demonstrating successful treatment and sustained remission.
Conclusion
Isavuconazole appears to be an effective alternative therapy for CCPH in patients with itraconazole hypersensitivity. Physicians should consider a graded challenge with structurally different azoles when itraconazole-induced hypersensitivity reactions occur, though larger clinical studies are needed.
- Published in:Medical Mycology Case Reports,
- Study Type:Case Report,
- Source: PMID: 40584598, DOI: 10.1016/j.mmcr.2025.100711