title: Elevated fluoride levels and periostitis in pediatric hematopoietic stem cell transplant recipients receiving long-term voriconazole.
abstract: Azole therapy is widely utilized in hematopoietic stem cell transplant (HCT) recipients for the treatment of aspergillus. Complications of voriconazole treatment related to its elevated fluoride content have been described in adults, including reports of symptomatic skeletal fluorosis. We review fluoride levels, clinical, and laboratory data in five pediatric HCT recipients on long-term voriconazole therapy, all found to have elevated serum fluoride levels. Two patients had toxic fluoride levels, one infant had symptoms of significant pain with movement and radiographs confirmed skeletal fluorosis. Monitoring fluoride levels in children, especially with skeletal symptoms, should be considered in patients on long-term voriconazole.
authors.affiliation: Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tarlock
authors.forename: Darren
authors.initials: D
authors.lastname: Johnson
authors.forename: Cathy
authors.initials: C
authors.lastname: Cornell
authors.forename: Shawn
authors.initials: S
authors.lastname: Parnell
authors.forename: Soheil
authors.initials: S
authors.lastname: Meshinchi
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects; D001847:Bone Diseases / Q000097:blood / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005459:Fluorides / Q000097:blood*; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D010522:Periostitis / Q000139:chemically induced*; D011379:Prognosis; D066027:Transplant Recipients; D065819:Voriconazole / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole; D005459:Fluorides
keywords: aspergillosis; infections in imunocompromised hosts; infectious disease; stem cell transplantation