Voriconazole-induced periostitis causing arthralgias mimicking a flare of granulomatosis with polyangiitis.

Abstract

We describe a case of voriconazole-induced periostitis that occurred in a 68-year-old woman with granulomatosis with polyangiitis. Our patient presented with months of severe hip pain limiting her daily activities, which was initially felt to be a flare of her granulomatosis with polyangiitis. However, upon further review, she had an elevated alkaline phosphatase and periostitis on her hip radiograph; voriconazole was held, and within 2 days she had marked improvement in her pain. Although this clinical syndrome is well documented in transplant patients, it is a rare complication in patients with autoimmune disorders. However, it is important because it may cause severe arthralgias that can mimic a flare of rheumatic diseases.

• Authors: Heather S Gladue, David A Fox
• Journal: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases (J Clin Rheumatol) Vol. 19 Issue 8 Pg. 444-5 (Dec 2013) ISSN: 1536-7355 [Electronic] United States
• PMID: 24263147 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Alkaline Phosphatase
• Voriconazole

Topics

• Aged
• Alkaline Phosphatase (blood)
• Antifungal Agents (adverse effects, therapeutic use)
• Arthralgia (diagnosis, etiology)
• Diagnosis, Differential
• Disease Progression
• Female
• Granulomatosis with Polyangiitis (diagnosis)
• Hip Joint
• Humans
• Periostitis (chemically induced)
• Pulmonary Aspergillosis (drug therapy)
• Pyrimidines (adverse effects, therapeutic use)
• Triazoles (adverse effects, therapeutic use)
• Voriconazole