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Various toxicities: case report A 36-year-old man developed ascending colon perforation and colonic wall thinning during treatment with dexamethasone, acute interstitial nephritis during treatment with posaconazole and liver toxicity during treatment with fluconazole as well as voriconazole. Additionally, he exhibited rebound of hypertension following clonidine taper [not all routes, dosages, durations of treatments to reactions onsets and outcomes stated]. The man presented with severe headache, vomiting and nausea. Investigations led to the diagnosis of coccidioidomycosis. Following a brief hospitalisation, he was discharged on oral dexamethasone 4mg every 6 hours and oral fluconazole 800mg daily. After several presentations for his refractory headaches, he was referred to an institution in the USA. Lumbar puncture demonstrated results compatible with a diagnosis of coccidioidomycosis meningitis (CM). In addition, he exhibited various cerebrovascular complications including haemorrhage and infarcts. He then started receiving oral fluconazole 1200mg daily and amphotericin-B liposomal [liposomal amphotericin-B]. Rapid resolution of symptoms was observed, and he was discharged on oral dexamethasone 15-day taper and oral fluconazole 800mg daily. After 9 days, he re-presented requiring hospitalisation due to worsening of underlying symptoms and was found to have a left cranial nerve-VI palsy as well as elevated aminotransferases. The man’s fluconazole therapy was replaced by oral voriconazole 400mg two times a day. While still inpatient, he exhibited a fall, altered mental status and hydrocephalus. He then underwent placement of an external ventricular drain followed by a ventriculoperitoneal shunt. Progression of his underlying disease was noted. Therefore, he started receiving IV dexamethasone 3mg every 6 hours with a 5-day taper to 1mg every 12 hours. Subsequently, his voriconazole therapy was changed to IV posaconazole 300mg daily due to liver toxicity, which was attributed voriconazole and fluconazole. Further, his posaconazole was discontinued temporarily due to suspicion of related acute interstitial nephritis. He received amphotericin-B therapy. During a third extended trial of oral dexamethasone tapering (27-day taper from 4mg every 6 hours to 1mg daily), he again developed altered mental status. Laboratory findings revealed a right thalamic infarct and a new left thalamic infarct. CT angiogram of his brain showed vasculitis versus vasospasm. Therefore, he started receiving posaconazole again in spite of the previous toxicity (i.e. acute interstitial nephritis). Additionally, he was continued on dexamethasone and amphotericin-B. He had been receiving clonidine with tapering. His systolic BP then started increasing and plateaued at 160–170mm Hg. After 2 nights, the systolic BP rapidly increased to 240mm Hg accompanied by an elevated pulse pressure and bradycardia. His hypertensive emergency and bradycardia were related to CM-induced vasospasm. In addition, his hypertensive emergency was considered as rebo