title: Voriconazole-associated myositis.
abstract: Voriconazole is a new triazole antifungal agent that is now the treatment of choice for invasive aspergillosis. Drug-induced myopathy has never previously been reported with voriconazole, although it is recognized with other triazole agents. We present a 34-year-old female African American renal transplant recipient, with a prior history of probable statin-induced myopathy, who developed severe generalized weakness with marked elevation of muscle enzymes and inflammatory changes on T2-weighted fat-suppressed STIR sequence magnetic resonance imaging (MRI) after commencing voriconazole for treatment of invasive aspergillosis. Her symptoms resolved and creatine kinase normalized upon stopping the drug.Given the increased use of triazoles in immunosuppressed and transplant recipients, it is important for rheumatology consultants to include this entity in their differential diagnosis of weakness in such patients.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Georgetown University Hospital, Washington, DC 20007, USA. vks4@gunet.georgetown.edu
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Shanmugam
authors.forename: Cal
authors.initials: C
authors.lastname: Matsumoto
authors.forename: Edward
authors.initials: E
authors.lastname: Pien
authors.forename: Jessica
authors.initials: J
authors.lastname: Rosen
authors.forename: Princy
authors.initials: P
authors.lastname: Kumar
authors.forename: Sean
authors.initials: S
authors.lastname: Whelton
authors.forename: Virginia
authors.initials: V
authors.lastname: Steen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology; D009220:Myositis / Q000139:chemically induced* / Q000175:diagnosis*; D009894:Opportunistic Infections / Q000188:drug therapy; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole