Voriconazole
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Periostitis: case report A 65-year-old woman developed periostitis following treatment with voriconazole for antifungal prophylaxis [time to reaction onset not stated]. The woman, who had undergone lung transplantation eight years ago, presented for evaluation of progressive swelling in both hands and diffuse body pain. Since transplantation, she had been receiving treatment with voriconazole daily as an antifungal prophylaxis [route and dose not stated]. Examination revealed prominent joint and soft-tissue swelling and pain in both hands, tenderness on palpation of the bony prominences of the shoulders, neck, elbows, lower back, and knees and restricted range of motion in both shoulders. ALP level was 742 U/L. Radiograph of hands revealed irregular, dense, nodular periostitis of the bones in her hands and wrists confirming the diagnosis of voriconazole-induced periostitis. The woman’s treatment with voriconazole was discontinued. Follow-up at 7-months revealed that the pain had decreased, but limitations in range of motion and bony swelling of the hands persisted. Author comment: "Voriconazole is a trifluorinated antifungal medication; the mechanism of the periostitis is thought to be related to the effects of fluoride on bone." Hedrick J, et al. Voriconazole-induced periostitis. New England Journal of Medicine 381: E30, No. 15, 10 Oct 2019. Available from: URL: http:// 803431786 doi.org/10.1056/NEJMicm1814565 - USA
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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