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Voriconazole-induced periostitis post lung transplantation

Orla M Murray1,2, John P Hynes1, Michelle A Murray3

  • 1Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.

Radiology Case Reports
|March 21, 2022
PubMed

Insights

Chronic voriconazole use can lead to diffuse periostitis, a rare complication in transplant recipients. This condition presents with bone pain and characteristic imaging findings, requiring careful monitoring.

Area of Science:

  • Pharmacology
  • Rheumatology
  • Infectious Diseases

Background:

  • Voriconazole is a broad-spectrum triazole antifungal crucial for treating invasive fungal infections, particularly in immunocompromised patients like transplant recipients.
  • Diffuse periostitis is an exceptionally rare adverse effect associated with prolonged voriconazole therapy.
  • This condition is characterized by diffuse bone pain, elevated serum alkaline phosphatase, and increased fluorine levels.

Observation:

  • A 71-year-old female lung transplant recipient developed multifocal bone pain.
  • The patient had a history of severe sepsis from Scedosporium apiospermum requiring lifelong voriconazole prophylaxis.
  • Clinical presentation included diffuse bone pain, elevated alkaline phosphatase, and hyperfluoridosis.

Findings:

  • The patient exhibited diffuse periostitis, a very rare complication of long-term voriconazole therapy.
  • Radiographic imaging revealed characteristic periosteal thickening with a dense, nodular, irregular, and bilateral pattern.
  • Laboratory findings showed elevated serum alkaline phosphatase and fluorine levels.

Implications:

  • This case underscores the importance of recognizing diffuse periostitis as a potential complication of chronic voriconazole therapy.
  • Early diagnosis through characteristic clinical and imaging findings is crucial for managing this rare adverse effect.
  • Understanding this complication may inform long-term monitoring strategies for patients on prolonged voriconazole prophylaxis.
Keywords:
Lung transplantationPeriostitisVoriconazole

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