QTc Interval Prolongation as an Adverse Event of Azole Antifungal Drugs: Case Report and Literature Review

• Published in: Microorganisms (Basel) Vol. 12; no. 8; p. 1619
• Main Authors: Kitaya, Shiori, Nakano, Makoto, Katori, Yukio, Yasuda, Satoshi, Kanamori, Hajime
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.08.2024; MDPI
• Subjects: Adverse events; Analysis; Antiarrhythmics; Antifungal agents; Arrhythmia; Arthritis; azole antifungal drugs; Cardiac arrhythmia; Cardiovascular diseases; Case reports; Case studies; Complications and side effects; Congenital diseases; Consciousness; Cytochrome; Demographics; Drugs; EKG; Electrocardiogram; Electrocardiography; Electrolytes; Fluconazole; Fungicides; Heart attacks; Heart failure; Hospitalization; Hypokalemia; Implants, Artificial; Joint replacement surgery; Knee; Literature reviews; Long QT syndrome; Medical research; Medicine, Experimental; Potassium; Prolongation; Prosthesis; QTc prolongation; Reagents; Remote monitoring; Review; Risk assessment; Risk factors; Risk groups; Safety management; Statistical analysis; Tazobactam; Telemedicine; torsade de pointes; Torsades de pointes; Voriconazole
• ISSN: 2076-2607; 2076-2607
• 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 Candida albicans-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.