Voriconazole-induced periostitis

  • D.C. Fernández Ávila | diana.fernandez@hospitalitaliano.org.ar Rheumatology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0002-7175-485X
  • 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.

Abstract

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.

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References

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Published
2021-04-19
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Section
Case Reports
Keywords:
Periostitis, voriconazole, bone pain, case report.
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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