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Voriconazole-induced periostitis in the hand
Gurbinder Singh1, Daria Motamedi2, Kevin Sweetwood2
1School of Medicine, University of California-San Francisco, 533 Parnassus Ave, San Francisco, CA, USA.
Abstract:
Voriconazole, a triazole antifungal, has proven effective against invasive fungal infections, and is often selected due to its enhanced antifungal spectrum coverage. Despite its general tolerability, voriconazole usage is associated with drug-induced periostitis, which presents with diffuse bone pain. This case report details a 65-year-old male on chronic immunosuppressive and antimicrobial therapy following heart transplant who developed hand pain. Identification of periostitis on hand radiographs and an acute elevation of alkaline phosphatase on subsequent blood analysis prompted discontinuation of voriconazole, resulting in a symptomatic and laboratory improvement. This case underscores the importance of leveraging a thorough understanding of imaging features, clinical manifestations, and laboratory data to aid in the diagnosis of voriconazole-induced periostitis.
Insights
Voriconazole, an antifungal medication, can cause drug-induced periostitis, a condition leading to bone pain. Early diagnosis through imaging and lab tests is crucial for prompt treatment and recovery.
Area of Science:
- Mycology
- Pharmacology
- Radiology
Background:
- Voriconazole is a triazole antifungal agent widely used for invasive fungal infections due to its broad spectrum of activity.
- While generally well-tolerated, voriconazole is associated with potential adverse effects, including drug-induced periostitis.
Observation:
- A 65-year-old male, post-heart transplant and on immunosuppressive therapy, presented with hand pain.
- Radiographic findings revealed periostitis, and laboratory tests showed elevated alkaline phosphatase levels.
Findings:
- Discontinuation of voriconazole led to significant symptomatic relief and normalization of alkaline phosphatase.
- This case highlights the link between voriconazole use and the development of periostitis.
Implications:
- Accurate diagnosis of voriconazole-induced periostitis requires integrating clinical presentation, radiographic evidence, and biochemical markers.
- Awareness of this adverse effect is essential for clinicians managing patients on voriconazole therapy, particularly those with prolonged use or on concomitant immunosuppressants.
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