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Stem cells are undifferentiated cells that divide and produce more stem cells or progenitor cells that differentiate into mature, specialized cell types. All the cells in the body are generated from stem cells in the early embryo, but small populations of stem cells are also present in many adult tissues including the bone marrow, brain, skin, and gut. These adult stem cells typically produce the various cell types found in that tissue—to replace cells that are damaged or to continuously...
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Voriconazole-Induced Periostitis After Allogeneic Stem Cell Transplantation.

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Area of Science:

  • Oncology
  • Pharmacology
  • Radiology

Background:

  • Allogeneic stem cell transplantation (SCT) is a critical treatment for hematologic malignancies.
  • Patients undergoing SCT often require antifungal prophylaxis and treatment, increasing the risk of drug-related side effects.
  • Voriconazole is a commonly used triazole antifungal agent with a known side effect profile.

Observation:

  • A 34-year-old male, post-SCT for Hodgkin lymphoma, developed severe, unexplained musculoskeletal pain.
  • Tc-MDP bone SPECT/CT revealed widespread periostitis with increased bone uptake.
  • The patient had been on voriconazole for an extended period to manage Aspergillus pneumonia.

Findings:

  • The clinical presentation and imaging findings were consistent with drug-induced periostitis.
  • Voriconazole was identified as the likely causative agent due to the absence of other potential etiologies.
  • Discontinuation of voriconazole and initiation of posaconazole led to rapid and complete symptom resolution.

Implications:

  • This case highlights the importance of considering drug-induced periostitis in patients on long-term voriconazole therapy, especially post-SCT.
  • Early recognition and management by switching antifungals can prevent prolonged morbidity.
  • Further research into the mechanisms of voriconazole-induced bone toxicity is warranted.