title: Voriconazole-induced periostitis in two post-transplant patients.
abstract: While drug-related periostitis has been known of for many years, the specific association of diffuse periostitis with voriconazole (most frequently in transplant patients) has only been recently explicitly addressed in the literature. Recognition of the radiologic and clinical manifestations of voriconazole-related periostitis is important for helping to narrow an otherwise broad differential diagnosis. We present two cases that illustrate different radiologic presentations of this painful cause of diffuse periostitis. Case 1 features a 60 year-old woman with a history of orthotopic heart transplant who was hospitalized for "full body pain" with progressively worsening bone tenderness involving the humeri, knees, femurs, hips, and hands. Case 2 describes a 48 year-old man with a history of acute lymphoblastic leukemia status post stem cell transplant who presented with diffuse arthralgias involving bilateral ankles, knees, wrists, and elbows.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Bucknor
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gross
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Link
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D010522:Periostitis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000188:drug therapy; D011743:Pyrimidines / Q000009:adverse effects*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D033581:Stem Cell Transplantation; D013669:Technetium Tc 99m Medronate; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000009:adverse effects*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D019275:Radiopharmaceuticals; D014230:Triazoles; D065819:Voriconazole; D013669:Technetium Tc 99m Medronate
keywords: Periostitis deformans; hypertrophic osteoarthropathy; lung transplant; voriconazole