Periostitis secondary to prolonged voriconazole therapy in lung transplant recipients.
We report five cases of possible drug-induced periostitis associated with long-term use of voriconazole therapy after lung transplantation (LT). The diagnosis of periostitis was made by the documentation of bone pain, elevation of serum alkaline phosphatase and characteristic findings on radionuclide bone imaging in the absence of any identifiable rheumatologic disease. This periostitis appears similar to hypertrophic osteoarthopathy (HOA) but does not meet all criteria for HOA. In all patients, the symptoms resolved rapidly after discontinuation of voriconazole therapy. Awareness of this potential syndrome, which manifests as bone pain, elevated serum alkaline phosphatase and a bone scan suggestive of periostitis, is necessary in LT recipients on long-term voriconazole.
Division of Internal Medicine, Department of Medicine, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, CA, USA.
T F
TF
Wang
T
T
Wang
R
R
Altman
P
P
Eshaghian
J P
JP
Lynch
D J
DJ
Ross
J A
JA
Belperio
S S
SS
Weigt
R
R
Saggar
A
A
Gregson
B
B
Kubak
R
R
Saggar
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000935:Antifungal Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010522:Periostitis / Q000139:chemically induced*; D055732:Pulmonary Aspergillosis / Q000188:drug therapy; D011743:Pyrimidines / Q000009:adverse effects*; D014230:Triazoles / Q000009:adverse effects*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000469:Alkaline Phosphatase; D065819:Voriconazole