title: Multifocal nodular periostitis associated with prolonged voriconazole therapy in a lung transplant recipient.
abstract: We report a case of painful, nodular periostitis in a lung transplant recipient on long-term voriconazole therapy. Symptoms, signs, and laboratory abnormalities resolved quickly after drug withdrawal. The presentation more closely resembles periostitis deformans than hypertrophic osteoarthropathy, suggesting that the fluoride moiety of voriconazole may be pathogenic for this condition. Clinicians should be aware of this association.
authors.affiliation: Department of Internal Medicine, Memorial Hospital, Jacksonville, FL 32216, USA. draayub@gmail.com
authors.forename: Asad
authors.initials: A
authors.lastname: Ayub
authors.forename: Charles V
authors.initials: CV
authors.lastname: Kenney
authors.forename: Fergus E
authors.initials: FE
authors.lastname: McKiernan
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000276:immunology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D010522:Periostitis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D055732:Pulmonary Aspergillosis / Q000188:drug therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D011859:Radiography; D011877:Radionuclide Imaging; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole