23 August 2026
: Case report 
Voriconazole-Induced Pancreatitis Despite Therapeutic Trough Concentrations During Treatment of Disseminated Fusariosis in a Hospitalized Patient
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction, Rare disease
Brunelda Aristilde ABDE 1, Marta E. Berguido de la Guardia
DEF 2, Kin F. Fentie EF 1, Michael Evans EFG 3, Libardo Rueda Prada ABCDEFG 3*
DOI: 10.12659/AJCR.953733
Am J Case Rep 2026; 27:e953733
Table 1 Clinical timeline of antifungal exposure and pancreatitis development.
| Hospital day | Clinical event | Key findings |
|---|---|---|
| Admission | Melena, severe cytopenias. Subcutaneous nodules and furuncles noted | |
| LAmB and isavuconazonium initiated | Treatment for invasive Fusarium infection | |
| Transitioned from Isavuconazonium to voriconazole | Loading dose 920 mg IV, then 200 mg PO BID | |
| Voriconazole trough obtained | 2.1 mcg/mL (ref. 1.0–5.5 mcg/mL) | |
| Voriconazole trough obtained | 1.0 mcg/mL (ref. 1.0–5.5 mcg/mL) | |
| Voriconazole trough obtained | 1.4 mcg/mL (ref. 1.0–5.5 mcg/mL) | |
| Initial abdominal symptoms | Mild LUQ abdominal discomfort and hiccups. Abdominal x-ray unrevealing | |
| Worsening abdominal painCT abdomen/pelvis obtained | Decreased oral intake, epigastric tenderness. CT A/P confirms acute interstitial edematous pancreatitis. Lipase 299 U/L (ref. 13–60 U/L) | |
| Voriconazole discontinued | Voriconazole discontinued. Transitioned back to isavuconazonium. Amphotericin B continued | |
| Clinical improvement | Abdominal pain improving | |
| Symptom resolution | Complete resolution of abdominal pain |