Fluconazole Hepatotoxicity — SCE Infectious Diseases MCQ

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EasyFungal InfectionsFluconazole HepatotoxicitySCE Infectious Diseases

A 45-year-old man on long-term Fluconazole prophylaxis for recurrent oropharyngeal candidiasis develops liver enzyme elevation (ALT 380 U/L, ALP 250 U/L). He has been on Fluconazole 100 mg daily for 8 months. What is the most likely cause?

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Correct answer: B — Fluconazole-induced hepatotoxicity — LFTs must be monitored during prolonged azole therapy

All azole antifungals can cause hepatotoxicity, and LFT monitoring is recommended during prolonged therapy. Fluconazole hepatotoxicity is usually reversible on discontinuation but can rarely progress to severe liver injury. Risk factors include high dose, prolonged duration, pre-existing liver disease, and concomitant hepatotoxic drugs. Management includes stopping Fluconazole, checking for other causes of liver injury, and switching to an alternative (Nystatin for oropharyngeal candidiasis, or a different azole with close monitoring if systemic antifungal is needed).

Reference: BNF 2024 – Fluconazole; BSAC 2024 – Antifungal safety monitoring