Repetitive edema in a patient treated by itraconazole

Purpose. We report the case of a patient who presented facial and lower lim b edema following treatment with itraconazole. Clinical case. A 24-year-old woman, suffering cystic fibrosis and diabetes mellitus, had received itraconazole (800 mg/day, day 1) following detection of Aspergillus fumigatus in bronchial aspiration. At day 9, the patient pr esented lower limb edema, then, at day 11, facial edema. Laboratory investi gation showed a high plasma level of itraconazole and of its active metabol ite (8,001 ng/mL), At day 16, itraconazole was stopped and a decrease of pl asma itraconazole level was observed with edema regression. Two months late r, a second cure with itraconazole was started and rapidly associated with lower limb edema. The plasma value of itraconazole equivalent (itraconazole and metabolite) at that point was 2,652 ng/mL. Discussion-conclusion. Edema have been observed concomitantly with itracona zole treatment associated with high plasma level of the drug. Symptoms have improved a few days after itraconazole has been removed. No other clinical or therapeutic events seemed to be related to the edema during this period . It should be pointed out that intestinal absorption of itraconazole could be high, even in case of cystic fibrosis, and that the drug plasma level h as to be monitored during the treatment, both to check intestinal absorptio n of the drug and to avoid possible secondary effects.