Although azole antifungals are typically considered the preferred therapy, echinocandins may be used for the treatment of esophageal candidiasis, if the Candida species is resistant to fluconazole or if drug interactions preclude the use of an azole antifungal, such as in this case. The authors note that this is the first known case of polymorphic ventricular tachycardia suggestive of torsades de pointes associated with micafungin therapy after switching from fluconazole. They conclude by stating “clinicians should be aware of this potential adverse event and monitor patients receiving concomitant drugs that can prolong QT interval.”


1. Shah, P. J., Sundareshan, V., Miller, B. and Bergman, S. J. (2016), Micafungin and a case of polymorphic ventricular tachycardia. Journal of Clinical Pharmacy and Therapeutics, 41: 362–364. doi: 10.1111/jcpt.12386