The authors would like to report on the case of an individual who developed psychosis, following pulse therapy of Itraconazole. We discuss his clinical presentation, history and similar reports in literature on Itraconazole.

Case-report, Literature review, Discussion.

Mr.X was a 36 year old male who developed an acute psychotic episode after starting his second course of pulse treatment of Itraconazole. Subsequently he had three inpatient admissions for his psychosis, in which he was treated informally

1. - initially with Olanzapine and Quetiapine, and following the third admission with Clozapine.

In the back ground of a negative history of any previous psychotic episode, no family history of psychosis or any mental illness, no concordant illicit substance abuse, and the emergence of clear cut psychotic symptoms at the age of 36 following treatment with a course of oral Itraconazole, our opinion is that Itraconazole has possibly contributed to the development of psychosis in a potentially vulnerable individual. Our literature review revealed only very few case reports of Itraconazole associated psychotic disorder.

This case highlights, although rare, the potential risk of idiosyncratic reactions and psychiatric manifestations associated with the antifungal agent Itraconazole. We recommend increased awareness amongst clinicians about the potential idiosyncratic reaction and risk of psychosis associated with Itraconazole and also the importance in highlighting such cases for the awareness of the public as well as clinicians.