Intractable Nausea in a Heart Transplant Patient

We present a case of a 59-year-old woman who had been recently diagnosed with a cavitary lung nodule and then started on voriconazole; she had been diagnosed with breast cancer about 10 years prior, which had been treated with anthracyclines and subsequent non-ischemic cardiomyopathy, ultimately requiring an orthotopic heart transplant. She presented to the hospital due to nausea and abdominal pain. She was found to have cholelithiasis, without cholecystitis, and was initially discharged with plans for an outpatient cholecystectomy. However, nausea and pain persisted, and hence she was readmitted and had a cholecystectomy but her nausea continued. Further workup revealed an elevated voriconazole level, and her nausea resolved once the voriconazole was discontinued.