https://doi.org/10.4081/reumatismo.2021.1368

Voriconazole-induced periostitis

Vol. 73 No. 1 (2021)
Submitted: 11 November 2020
Accepted: 23 January 2021
Published: 19 April 2021
Periostitis, voriconazole, bone pain, case report.
Abstract Views: 3545
PDF: 601
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

D.C. Fernández Ávila
diana.fernandez@hospitalitaliano.org.ar
https://orcid.org/0000-0002-7175-485X
Rheumatology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
M. Diehl
Metabolic bone disease Section, Endocrinology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
A.M. Degrave
Metabolic bone disease Section, Endocrinology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
M. Buttazzoni
Metabolic bone disease Section, Endocrinology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
T. Pereira
Metabolic bone disease Section, Endocrinology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
M.A. Aguirre
Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
A.L. Basquiera
Hematology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
M. Scolnik
Rheumatology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients. Chronic use of this medication can generate, as an adverse effect, a multifocal, asymmetric, diffuse and nodular periosteal reaction, associated with severe and disabling skeletal pain and elevated alkaline phosphatase and serum fluoride. Radiography is the imaging technique of choice for periostitis diagnosis. In general, clinical manifestations and radiographic findings disappear, when the drug is discontinued. We report the clinical case of a 44 year-old woman diagnosed with acute myeloid leukemia, who developed an invasive fungal infection treated with voriconazole after a stem cell transplant. Nine months after starting antifungal treatment, she manifested symptoms and radiological signs compatible with periostitis. Due to clinical suspicion, we decided to suspend voriconazole, with consequent resolution of clinical manifestations and radiological findings.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Levine MT, Chandrasekar PH. Adverse effects of voriconazole: Over a decade of use. Clin Transplant. 2016; 30: 1377-86. DOI: https://doi.org/10.1111/ctr.12834
Gayan Belmonte MJ, Botía González CM, García Gerónimo A, et al. Voriconazole-induced periostitis: radiological clues for its diagnosis. J Clin Rheumatol. 2019; 25: E67. DOI: https://doi.org/10.1097/RHU.0000000000000646
Skaug M, Spak C, Oza U. Painful periostitis in the setting of chronic voriconazole therapy. Baylor Univ Med Cent Proc. 2014; 27: 350-2. DOI: https://doi.org/10.1080/08998280.2014.11929156
Benitez LL, Carver PL. Adverse effects associated with long-term administration of azole antifungal agents. Drugs [Internet]. 2019; 79: 833-53. DOI: https://doi.org/10.1007/s40265-019-01127-8
Adwan MH. Voriconazole-induced periostitis: a new rheumatic disorder. Clin Rheumatol [Internet]. 2017; 36: 609-15. DOI: https://doi.org/10.1007/s10067-016-3341-7
Rad B, Saleem M, Grant S, et al. Fluorosis and periostitis deformans as complications of prolonged voriconazole treatment. Ann Clin Biochem. 2015; 52: 611-4. DOI: https://doi.org/10.1177/0004563214568873
. Geneva WHO. WHO (2010). Preventing disease through healthy environments inadequate or excess fluoride: a major public health concern [Internet]. [cited 2020 Nov 7]. Available from: https://www.who.int/ipcs/features/fluoride.pdf?ua=1
Tan I, Lomasney L, Stacy GS, et al. Spectrum of voriconazole-induced periostitis with review of the differential diagnosis. Am J Roentgenol. 2019; 212: 157-65. DOI: https://doi.org/10.2214/AJR.18.19991
Gerber B, Guggenberger R, Fasler D, et al. Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole. Blood. 2012; 120: 2390-4. DOI: https://doi.org/10.1182/blood-2012-01-403030
Moon WJ, Scheller EL, Suneja A, et al. Plasma fluoride level as a predictor of voriconazole-induced periostitis in patients with skeletal pain. Clin Infect Dis. 2014; 59: 1237-45. DOI: https://doi.org/10.1093/cid/ciu513
Elmore S, Wisse A, Chapin RW, Whelan TP, Silver RM. Voriconazole-associated periostitis presenting as hypertrophic osteoarthropathy following lung transplantation report of two cases and review of the literature. Semin Arthritis Rheum. 2019; 49: 319-23. DOI: https://doi.org/10.1016/j.semarthrit.2019.04.003
Yap FY, Skalski MR, Patel DB, et al. Hypertrophic osteoarthropathy: clinical and imaging features. Radiographics. 2017; 37: 157-75. DOI: https://doi.org/10.1148/rg.2017160052

How to Cite

Fernández Ávila, D., Diehl, M., Degrave, A., Buttazzoni, M., Pereira, T., Aguirre, M., Basquiera, A., & Scolnik, M. (2021). Voriconazole-induced periostitis. Reumatismo, 73(1), 44–47. https://doi.org/10.4081/reumatismo.2021.1368

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.