Patient With Probable Invasive Pulmonary Aspergillosis and Idiopathic Bilateral Chylothorax With Chylopericardium May Experience Unachievable Therapeutic Voriconazole Serum Levels

Voriconazole (VRZ) is an effective first-line treatment for invasive pulmonary aspergillosis. This case report aims to describe the unachievable therapeutic VRZ serum levels in a patient with probable invasive pulmonary aspergillosis and idiopathic bilateral chylothorax with chylopericardium requiring intercostal drainage. Moreover, extrahepatic VRZ loss via intercostal drainage was observed by measuring VRZ in the chylous fluid, which was comparable to the serum concentration.