MICONAZOLE-INDUCED FATAL DYSRHYTHMIA

Miconazole is an imidazole antifungal agent that is available in topic al, vaginal, and parenteral formulations. Indications for the parenter al product have become rare with the development of newer, more effect ive agents. A 54-year-old man who had undergone orthotopic heart trans plantation developed a widespread subcutaneous Scopulariopsis infectio n that progressed despite treatment with amphotericin B and itraconazo le. Intravenous miconazole was added to his regimen. During the infusi on he developed a bradyarrhythmia that resolved after miconazole was d iscontinued. On rechallenge with a lower dosage, bradyarrhythmia recur red and progressed to ventricular fibrillation. The patient died despi te full resuscitation efforts. Only a few case reports exist of micona zole-induced cardiac arrhythmias, and these events were attributed to rapid intravenous administration, insufficient dilution, and the drug' s vehicle. We believe that intravenous miconazole should be given with caution to patients with underlying heart disease.