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Voriconazole-induced periostitis

D C Fernández Ávila1, M Diehl2, A M Degrave2

  • 1Rheumatology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires. diana.fernandez@hospitalitaliano.org.ar.

Reumatismo
|April 20, 2021
PubMed

Insights

Chronic voriconazole use can cause periostitis, a painful bone condition, in immunosuppressed patients. Discontinuing the drug typically resolves these adverse effects, as seen in a leukemia patient case.

Area of Science:

  • Pharmacology
  • Radiology
  • Oncology

Background:

  • Voriconazole, a triazole antifungal, is crucial for treating fungal infections in immunocompromised individuals.
  • Chronic voriconazole therapy can lead to adverse effects, including periostitis, skeletal pain, and elevated alkaline phosphatase and serum fluoride levels.
  • Periostitis diagnosis relies on radiography, and symptoms often resolve upon drug cessation.

Observation:

  • A 44-year-old female with acute myeloid leukemia developed invasive fungal infection post-stem cell transplant.
  • She received voriconazole treatment and subsequently presented with symptoms and radiographic signs of periostitis.
  • Clinical manifestations included severe skeletal pain and elevated alkaline phosphatase and serum fluoride levels.

Findings:

  • Radiographic imaging confirmed a multifocal, asymmetric, diffuse, and nodular periosteal reaction.
  • Discontinuation of voriconazole therapy resulted in the complete resolution of clinical symptoms and radiographic findings.
  • This case highlights the diagnostic utility of radiography in identifying drug-induced periostitis.

Implications:

  • This case underscores the importance of recognizing voriconazole-induced periostitis as a potential adverse effect.
  • Prompt diagnosis and drug withdrawal can lead to favorable patient outcomes and symptom resolution.
  • Clinicians should consider voriconazole toxicity in immunocompromised patients presenting with unexplained skeletal pain and periosteal reactions.

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