Twelve patients developed hallucinations (). A detailed description of the symptoms follows.
Characteristics of 12 patients who experienced hallucinations after receiving voriconazole treatment
Patient 1 complained of blurred vision, changes of colors, and visual hallucinations on the first day of intravenous voriconazole therapy. She saw several unfamiliar, silent people going in and out of her room. This was more intense when her eyes were closed and during the night. The experience was not disturbing. All symptoms disappeared on the fifth day of treatment when the treatment was discontinued.
Patient 2 reported seeing images of beautiful places and landscape during receipt of loading doses of intravenous voriconazole treatment. He saw scenic images that he thought might be Montana or New York City. During the night, he heard gurgling water around him, preventing him from sleeping. Symptoms disappeared on the third day, when intravenous voriconazole treatment was switched to oral voriconazole treatment.
A few hours after intravenous voriconazole treatment initiation, patient 3 began to have the impression that he could move objects with his eyes. He also had the impression that he was being transferred to different hospital wards and even to the intensive care unit during the night. This caused him to have considerable anxiety, and voriconazole treatment was discontinued on day 3. All symptoms resolved shortly after treatment discontinuation.
Patient 4 had experienced hallucinations after receiving voriconazole several months before his second course of treatment. On this second occasion, he developed visual hallucinations at his home 8 days after oral voriconazole treatment was initiated, and the treatment was discontinued. The patient described seeing ugly and unfamiliar faces.
Patient 5 developed both auditory and visual hallucinations. Visual hallucinations consisted of flying objects and a sense of his floating in the room. He also saw Christmas trees flying around the room and saw himself traveling to beautiful places. Auditory symptoms included television commercials and Christmas carols. All symptoms disappeared on the fifth day after discontinuation of voriconazole treatment.
On the first day of treatment, patient 6 saw a figure bending over him when he closed his eyes. The figure looked large and hairy but not threatening, like the character Chewbacca from the Star Wars films. That day, the patient also had the impression that his bed was moving around the room, and he saw a gray background when reading. Symptoms resolved on day 4 when voriconazole treatment was stopped.
Patient 7 developed visual and auditory hallucinations on the first day of treatment. The patient reported seeing beautiful places and scenery, as if traveling on a train. She also reported seeing furniture moving around her room. Unfamiliar faces came close to her face, as if wanting to kiss her, and she heard loud music coming from outside her room, as if someone were having a party. The hallucinations were increased during the night when her eyes were closed. They disappeared on day 5—1 day after intravenous treatment was switched to oral treatment.
Patient 8 admitted hearing voices give orders to her, as if she was doing something wrong, 6 days after beginning intravenous voriconazole treatment. She also saw people walking in and out of her room during the night as she was trying to sleep and when her eyes were closed. Voriconazole treatment was discontinued because of hepatotoxicity 2 days later, and all symptoms disappeared.
Patient 9 described seeing cockroach-like bugs in his hospital room. He also saw unknown people flying around his room, and at other times, he would see his job office and several coworkers. The symptoms were present in variable intensity for 4 days. Although during the first 2 days, he considered the experience to be funny, the hallucinations later became annoying, and voriconazole treatment was stopped. The patient did not experience auditory hallucinations.
Patient 10 saw scenes as if he were walking around in a house that he did not recognize. This began on the first day that he was treated and continued even when intravenous therapy was changed to oral therapy on the third day. Symptoms disappeared overnight after the drug was stopped on the fifth day. The patient was unable to sleep well, because these scenes appeared when he closed his eyes. He related that he had previously received voriconazole at a different hospital, but the treatment had been stopped when he complained that he saw a man crashing through the door into his room, frightening him.
Patient 11 saw a cat scurrying around his hospital room and hiding under the furniture. His wife's brown hair looked purple, but other colors were normal. Symptoms were present only on the first day, although therapy was continued for 10 days.
Patient 12 thought that the furniture in his hospital room was floating around on his first day of intravenous treatment. The symptoms disappeared on the second day. He was switched to oral treatment 9 days later and was still receiving voriconazole at hospital discharge 20 days after the initiation of treatment.