Voriconazole-induced periostitis: beyond post-transplant patients

Area of Science:

• Pharmacology
• Radiology
• Rheumatology

Background:

• Voriconazole-induced periostitis (VIP) is a rare adverse effect of voriconazole, an antifungal medication.
• While often reported in transplant recipients on immunosuppressants, non-transplant patients are also at risk.

Observation:

• This case highlights VIP in an immunocompetent, non-transplant patient with a history of fungal infection in an abdominal aortic stent graft.
• The patient was on long-term suppressive voriconazole therapy.

Findings:

• Delayed diagnosis is common in non-transplant patients due to unfamiliarity with VIP outside of immunosuppressed populations.
• Radiologists play a crucial role in identifying periostitis on imaging and reviewing patient medication lists.

Implications:

• Prompt diagnosis of VIP can be facilitated by radiologist awareness and correlation with voriconazole use.
• Early identification and treatment can lead to symptom resolution and prevent further complications.