title: Voriconazole-induced periostitis in a patient with overlap syndromes.
abstract: A 52-year-old woman with overlap syndrome and interstitial pneumonia underwent immunosuppressive therapy and she was suspected to suffer from pulmonary aspergillosis. Oral voriconazole was initiated, and a rapid elevation of alkaline phosphatase (ALP) occurred after 4 weeks. After 2 months, the patient presented diffuse pain in bilateral skeletal regions, and bone scintigraphy revealed bilateral multiple areas of increased radiotracer uptake. We suspected the skeletal involvement as voriconazole-induced periostitis. Actually, the plasma fluoride level was increased. Voriconazole was replaced with itraconazole, and after 3 weeks, the patient stopped complaining of bone pain concomitant with the decrease in ALP. Voriconazole-induced periostitis is a rare condition but had previously been reported in solid organ or patients with bone marrow transplant who received a long-term voriconazole therapy. Our present case is distinctive of previous ones, because it occurred in a patient with connective tissue disease which had its rapid progression.
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Keisho
authors.initials: K
authors.lastname: Hirota
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasoda
authors.forename: Toshihito
authors.initials: T
authors.lastname: Fujii
authors.forename: Nobuya
authors.initials: N
authors.lastname: Inagaki
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010522:Periostitis / Q000139:chemically induced* / Q000175:diagnosis; D055732:Pulmonary Aspergillosis / Q000188:drug therapy* / Q000276:immunology; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D065819:Voriconazole / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D065819:Voriconazole