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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
Summary
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.
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