title: 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.affiliation: From the Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Gladue
authors.forename: David A
authors.initials: DA
authors.lastname: Fox
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis; D006621:Hip Joint; D006801:Humans; D010522:Periostitis / Q000139:chemically induced*; D055732:Pulmonary Aspergillosis / 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; D011743:Pyrimidines; D014230:Triazoles; D000469:Alkaline Phosphatase; D065819:Voriconazole