Unexpected Voriconazole Overexposure in a CYP2C19 Rapid Metabolizer Due to Inflammation-Induced Phenoconversion: A Short Communication.
Guillaume Drevin, Nicolas Picard, Marie Briet et al.
✦ AI-curated · Sources linked
Case in brief
An adult patient on voriconazole exhibited significant drug overexposure despite being a CYP2C19 rapid metabolizer. Elevated voriconazole levels were noted alongside increased C-reactive protein, indicating a significant inflammatory state. As inflammation subsided, voriconazole concentrations decreased, demonstrating the impact of inflammation on drug metabolism and the phenomenon of phenoconversion.
What made this case unusual
The case illustrates inflammation-induced phenoconversion, where systemic inflammation led to unexpected voriconazole overexposure in a genetically predicted rapid metabolizer.
Diagnostic / clinical pearl
Clinicians should consider the effects of systemic inflammation on drug metabolism, particularly in patients with pharmacogenetic profiles suggesting normal enzyme activity.
Why it matters
Understanding inflammation's role in altering drug metabolism can enhance the safety and effectiveness of treatments like voriconazole, particularly in patients with complex clinical presentations.