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Voriconazole-Induced Periostitis: A Case Report

Tristan D Cooper-Roth1, Caleb R Boehler1, Stefano J Natali1

  • 1Radiology, University of Arizona College of Medicine-Tucson, Tucson, USA.

Cureus
|October 27, 2023
PubMed

Insights

Voriconazole-induced periostitis (VIP) is a rare side effect causing bone pain and fractures in immunocompromised patients. Consider VIP in patients with a history of organ transplant and long-term voriconazole use.

Area of Science:

  • Pharmacology
  • Orthopedics
  • Rheumatology

Background:

  • Voriconazole-induced periostitis (VIP) is an uncommon adverse effect of prolonged voriconazole therapy.
  • It primarily affects immunosuppressed patients, often those with a history of solid organ transplantation.
  • Clinical manifestations include bone pain, fragility, and elevated alkaline phosphatase (ALP).

Observation:

  • A 72-year-old immunocompromised female presented with a comminuted intertrochanteric fracture after a ground-level fall.
  • The patient was undergoing long-term antifungal therapy with voriconazole.
  • Radiographic features suggested periostitis, prompting consideration of VIP.

Findings:

  • Voriconazole-induced periostitis (VIP) should be considered in the differential diagnosis for patients presenting with bone pain and/or fractures.
  • Radiographic findings of periostitis in conjunction with a history of organ transplant and long-term voriconazole use are key indicators.
  • Diagnosis is confirmed by excluding underlying rheumatologic diseases and reviewing medication history.

Implications:

  • Early recognition of VIP can prevent misdiagnosis and inappropriate treatment for fractures.
  • Awareness among clinicians is crucial for managing patients on long-term voriconazole therapy.
  • This case highlights the importance of a thorough medication review in patients with unexplained bone pathology.
Keywords:
msk radiologymusculoskeletal radiologyperiostitisvoriconazole therapyvoriconazole toxicity

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