Pulmonary arterial hypertension caused by coadministration of dasatinib and voriconazole: A case report and literature review.

RATIONALE: It has been demonstrated that azole antifungal agents can significantly increase the plasma concentration of dasatinib. Therefore, it is recommended to reduce the dasatinib dose to 20 to 40 mg daily for patients receiving voriconazole. However, the safety of coadministering dasatinib and voriconazole remains unclear.

PATIENT CONCERNS: A 49-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia and invasive pulmonary aspergillosis reported dyspnea during therapy with reduced-dose dasatinib and standard-dose voriconazole.

DIAGNOSES: Echocardiography revealed pleural effusion and a mean pulmonary arterial pressure of 40 mm Hg, suggesting pulmonary arterial hypertension.

INTERVENTIONS: Dasatinib was discontinued and flumatinib was initiated.

OUTCOMES: The patient's mean pulmonary arterial pressure was monitored and gradually normalized.

LESSONS: Despite recommendations to reduce the dasatinib dose to 20 to 40 mg daily for patients on voriconazole, the enhanced effect of dasatinib due to voriconazole coadministration may contribute to the development of pulmonary arterial hypertension. Regular echocardiography follow-up is essential for patients concurrently taking azole antifungal agents.