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Abstract: SA-PO474

Isavuconazonium Sulfate Associated Acute Hyponatremia

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Maturostrakul, Boonyanuth N., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Nimkar, Abhishek, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Pariswala, Tanazul T., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Shah, Hitesh H., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
Introduction

Isavuconazonium sulfate is an azole antifungal agent approved by the US FDA for the treatment of invasive aspergillosis and mucormycosis. Isavuconazonium sulfate has been associated with several electrolyte disorders including hypokalemia and hypomagnesemia. Hyponatremia has rarely been associated with Isavuconazonium sulfate in clinical trials. Here, we present an interesting case of isavuconazonium associated acute hyponatremia

Case Description

72-year-old male with history of liver and kidney transplantation, on immunosuppressives presented to the hospital because of painless mono-ocular vision loss and chronic headache. Pt. was subsequently found to have aspergillus infection of the left cavernous sinus (that was confirmed by tissue biopsy). Mycophenolate mofetil was held in view of active aspergillus infection. Pt. was initially started on amphotericin B treatment but was later switched to intravenous isavuconazonium sulfate (for his invasive fungal infection). Before initiation of isavuconazonium sulfate, serum sodium (SNa) was in normal range at 136 mmol/L. After initiating isavuconazonium sulfate, SNa progressively decreased to 121 mmol/L over the next 10 days. Pt. was clinically euvolemic on exam. Work-up for hyponatremia showed low serum osmolarity of 273 mosm/kg, urine sodium of 163 mmol/L and urine osmolarity of 484 mosm/kg. Both TSH and AM serum cortisol levels were in normal range. Pt. was initiated on oral salt tablets and fluid restriction. Isavuconazonium sulfate was discontinued for severe hyponatremia and patient was initiated on intravenous voriconazole. SNa progressively improved to 134 mmol/L, 10 days after discontinuation of isavuconazonium sulfate.

Discussion

Solid organ transplant recipients are at increased risk for serious bacterial, viral, and fungal infections. Our patient presented with invasive aspergillosis. Treatment with isavuconazonium sulfate, a systemic antifungal medication resulted in acute severe euvolemic hyponatremia. Hyponatremia has shown to be an uncommon adverse effect (<5%) of this agent in clinical trials. While the exact mechanism of isavuconazonium sulfate associated hyponatremia is unknown, serum sodium levels progressively improved in our patient after discontinuation of this agent. Clinicians should be aware of this potential and reversible adverse effect of this agent.