Voriconazole-induced cholestatic hepatotoxicity in fungal pneumonia

Voriconazole is a widely used antifungal agent for invasive aspergillosis; however, hepatotoxicity is a significant concern. While hepatocellular toxicity is well documented, cholestatic liver injury remains relatively rare. We report a case of voriconazole-induced cholestatic hepatotoxicity in a patient with fungal pneumonia. The patient developed elevated alkaline phosphatase and gamma-glutamyl transpeptidase levels beyond the therapeutic range. Voriconazole was discontinued, and the patient was switched to posaconazole, leading to a decline in cholestatic markers. This report underscores the importance of therapeutic drug monitoring and highlights posaconazole as a safer alternative in patients experiencing voriconazole-induced hepatotoxicity.