Itraconazole-Induced Psychosis: A Case Report

Psychiatric manifestations as side effects of antifungal therapies are rare and most often associated with second- and third-generation agents. This case report describes a rare incident of first-episode psychosis following itraconazole therapy in a male patient in his 50s with no previous psychiatric history or identifiable risk factors for psychosis. The onset of visual and auditory hallucinations, persecutory delusions, and disturbed sleep coincided with antifungal treatment for Aspergillus fumigatus infection. Physical, biochemical, and radiological investigations revealed no alternative cause for his presentation. Symptoms resolved following discontinuation of itraconazole and initiation of olanzapine, further supporting itraconazole as the likely precipitant. The patient has remained well with no recurrence of psychotic symptoms to date. Currently, only a limited number of similar cases following antifungal use have been reported in the literature, and fewer still following the specific use of itraconazole. This report aims to raise clinician awareness of this potential adverse effect to support safer antifungal prescribing, particularly for patients at higher risk of developing psychotic symptoms. Despite its rarity, increased vigilance may help prevent severe psychotic episodes in previously well individuals.