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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.
Radiology Case Reports
|January 14, 2025
Summary
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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