Rhabdomyolysis induced by concomitant voriconazole and trimethoprim-sulfamethoxazole in a patient with pulmonary fungal infection: a case report

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Author: ZHANG Jiajun ^1, ²  WANG Zhen ¹ ZHOU Ying ³ ZHANG Peng ^1, ⁴ GONG Xuepeng ¹

Affiliation: 1. Department of Pharmacy, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China 2. Department of Pharmacy, The Fifth Affiliated Hospital of Kunming Medical University, Honghe 661000, Yunnan Province, China 3. Department of Respiratory and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China 4. Department of Pharmacy, Affiliated Hospital of Clinical Medical College, Jiujiang University, Jiujiang 332000, Jiangxi Province, China

Keywords: Voriconazole Trimethoprim-sulfamethoxazole Rhabdomyolysis Adverse drug reaction

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Abstract

A 67-year-old female patient with pulmonary fungal infection developed rhabdomyolysis following treatment with voriconazole and trimethoprim-sulfamethoxazole (TMP-SMZ). On day 11 of medication administration, the patient experienced bilateral lower limb weakness and became unable to ambulate. Laboratory findings revealed a creatine kinase level of 11,034 U·L^-1 and myoglobin >1,200.0 ng·mL^-1, confirming the diagnosis of rhabdomyolysis. Voriconazole was immediately discontinued, and symptomatic management, including hydration, urine alkalinization, and anti-inflammatory therapy was initiated, the symptoms gradually improved. The Naranjo’s Assessment Scale was applied to assess the association between the suspected drugs of voriconazole and TMP-SMZ, and the adverse event. Voriconazole scored 4 points, while TMP-SMZ scored 3 points, the results were all “probably related”. Based on the patient’s clinical status, voriconazole was deemed more likely to be causative. This case highlights the potential increased risk of rhabdomyolysis when voriconazole is co-administered with TMP-SMZ. Clinicians should enhance medication evaluation, strengthen monitoring, and conduct early diagnosis in such scenarios.

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References

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