Voriconazole-induced periostitis in a patient with overlap syndromes.

Abstract

A 52-year-old woman with overlap syndrome and interstitial pneumonia underwent immunosuppressive therapy and she was suspected to suffer from pulmonary aspergillosis. Oral voriconazole was initiated, and a rapid elevation of alkaline phosphatase (ALP) occurred after 4 weeks. After 2 months, the patient presented diffuse pain in bilateral skeletal regions, and bone scintigraphy revealed bilateral multiple areas of increased radiotracer uptake. We suspected the skeletal involvement as voriconazole-induced periostitis. Actually, the plasma fluoride level was increased. Voriconazole was replaced with itraconazole, and after 3 weeks, the patient stopped complaining of bone pain concomitant with the decrease in ALP. Voriconazole-induced periostitis is a rare condition but had previously been reported in solid organ or patients with bone marrow transplant who received a long-term voriconazole therapy. Our present case is distinctive of previous ones, because it occurred in a patient with connective tissue disease which had its rapid progression.

• Authors: Keisho Hirota, Akihiro Yasoda, Toshihito Fujii, Nobuya Inagaki
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2014 (Mar 05 2014) ISSN: 1757-790X [Electronic] England
• PMID: 24599432 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antifungal Agents
• Immunosuppressive Agents
• Voriconazole

Topics

• Antifungal Agents (adverse effects, therapeutic use)
• Female
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Middle Aged
• Periostitis (chemically induced, diagnosis)
• Pulmonary Aspergillosis (drug therapy, immunology)
• Rheumatic Diseases (complications, drug therapy)
• Voriconazole (adverse effects, therapeutic use)