Voriconazole induced photosensitivity

This man with immunocompromised with autoimmune disease developed bilateral invasive aspergillosis and a galactomannan antigen OD in BAL of 9.0. He was started on voriconazole and responded well. Some weeks later his face became erythematous and slightly uncomfortable. The photographs show the remarkable extent of his voriconazole photosensitivity with very little conjunctivitis or cheilitis (lip dryness). Monochromator testing to narrow band UVB, UVA and visible light and provocation testing was within normal limits. Voriconazole was stopped after 9 months of therapy and reduction of immunosuppression, with resolution of photosensitivity.