Fluconazole-induced torsade de pointes

OBJECTIVE: To present a case of fluconazole-associated torsade de pointes ( TDP) and discuss fluconazole's role in causing TDP. CASE SUMMARY: A 68-year-old white woman with Candida glabrata isolated from a presacral abscess developed TDP eight days after commencing oral flucona zole. The patient had no other risk factors for TDP, including coronary art ery disease, cardiomyopathy, congestive heart failure, and electrolyte abno rmalities. There was a temporal association between the initiation of fluco nazole and TDP. The TDP resolved when fluconazole was discontinued; however , the patient continued to have premature ventricular contractions and nons ustained ventricular tachycardia (NSVT) until six days after drug cessation . DISCUSSION: Use of the Naranjo probability scale indicates a probable relat ionship between the use of fluconazole and the development of TDP. The poss ible mechanism is depression of rapidly activating delayed rectifier potass ium currents. In our patient, there was no other etiology identified that c ould explain QT prolongation or TDP. The complete disappearance of NSVT and premature ventricular contractions followed by normalization of QT interva l after the drug was stopped strongly suggests fluconazole as the etiology. CONCLUSIONS: Clinicians should be aware that fluconazole, even at low doses , may cause prolongation of the QT interval, leading to TDP, Serial electro cardiographic monitoring may be considered when fluconazole is administered in patients who are at risk for ventricular arrhythmias.