Heart failure induced by itraconazole
A 60-year-old female patient presented with the complaints of shortness of breath and swelling of the legs for 5 days. She was referred to cardiology clinic and was prescribed 2 × 200 mg/day of oral itraconazole; therapy was initiated 5 days ago by a dermatologist with the diagnosis of onychomycosis. On physical examination, blood pressure was: 130/80 mmHg, cardiac examination was normal, respiratory sounds decreased in basilar of both lungs. There was bilateral pretibial edema. Her electrocardiography and echocardiography were normal. Density in right lower zone and blunting of the right sinus in chest X-ray was observed. Patient was referred to pneumonology clinic. There was no infection or primary pulmonary disease. Patient had no cardiovascular disease or any other cardiac pathology before. The complaints appeared after initiation of itraconazole. According to Framingham study the patients had three minor criteria and major criteria as cause of complaints and findings that's why patients were accepted heart failure. As there was no other cause itraconazole[] was considered to be the culprit drug. Oral itraconazole was discontinued and patient was treated with 1 × 40 mg/day furosemide. Patient recovered within a week. Control echocardiography was normal. Exercise stress test was performed to eliminate coronary artery disease, which is a reason for heart failure and the test was normal. Thus, the patient's clinical signs and symptoms were thought to be due to itraconazole and not to any ischemic event with a probable causality relationship as analyzed by World Health Organization — Uppsala Monitoring Center Criteria.