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Reumatismo Apr 2021Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients....
Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients. Chronic use of this medication can generate, as an adverse effect, a multifocal, asymmetric, diffuse and nodular periosteal reaction, associated with severe and disabling skeletal pain and elevated alkaline phosphatase and serum fluoride. Radiography is the imaging technique of choice for periostitis diagnosis. In general, clinical manifestations and radiographic findings disappear, when the drug is discontinued. We report the clinical case of a 44 year-old woman diagnosed with acute myeloid leukemia, who developed an invasive fungal infection treated with voriconazole after a stem cell transplant. Nine months after starting antifungal treatment, she manifested symptoms and radiological signs compatible with periostitis. Due to clinical suspicion, we decided to suspend voriconazole, with consequent resolution of clinical manifestations and radiological findings.
Topics: Adult; Antifungal Agents; Female; Humans; Periostitis; Radiography; Triazoles; Voriconazole
PubMed: 33874646
DOI: 10.4081/reumatismo.2021.1368 -
The New England Journal of Medicine Oct 2019
Topics: Aged; Antifungal Agents; Female; Hand Bones; Humans; Immunocompromised Host; Lung Transplantation; Periostitis; Radiography; Voriconazole
PubMed: 31597023
DOI: 10.1056/NEJMicm1814565 -
Clinical Rheumatology Mar 2017Over the past few years, several reports of periostitis affecting patients treated with voriconazole appeared in the literature. As rheumatologists are likely to be... (Review)
Review
Over the past few years, several reports of periostitis affecting patients treated with voriconazole appeared in the literature. As rheumatologists are likely to be called to see such patients, a review of the reported cases was undertaken. A systematic search of Pubmed and Google scholar for case reports, case series and observational studies was undertaken. Twenty-six articles including 23 case reports/case series (total 40 patients), a prospective study and two retrospective studies of 58 cases were included. Age ranged from 3 months to 77 years. Eleven cases (27.5 %) were male and 29 cases (72.5 %) were female. The duration of treatment varied from 6 weeks to 8 years (mean 53.6, SD 77.4 weeks). Most cases presented with diffuse skeletal pain affecting various sites in association with elevated alkaline phosphatase. Periostitis is increasingly reported and should be considered in patients taking voriconazole who present with bone pain and/or alkaline phosphatase elevation.
Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Antifungal Agents; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Periostitis; Voriconazole; Young Adult
PubMed: 27376754
DOI: 10.1007/s10067-016-3341-7 -
AJR. American Journal of Roentgenology Jan 2019Voriconazole is an antifungal medication used primarily for the treatment of Candida and Aspergillus infections. A fairly newly described side effect of long-term... (Review)
Review
OBJECTIVE
Voriconazole is an antifungal medication used primarily for the treatment of Candida and Aspergillus infections. A fairly newly described side effect of long-term voriconazole use is periostitis. The purpose of this article is to describe the main differential consideration-hypertrophic osteoarthropathy-and other differential diagnoses, including venous stasis, thyroid acropachy, and hypervitaminosis A.
CONCLUSION
With knowledge of imaging appearance, clinical manifestations, and outcomes, radiologists can make an accurate diagnosis of voriconazole-induced periostitis, and clinical teams can initiate appropriate management.
Topics: Antifungal Agents; Diagnosis, Differential; Humans; Periostitis; Voriconazole
PubMed: 30403528
DOI: 10.2214/AJR.18.19991 -
Ugeskrift For Laeger Apr 2019In this case report, a 49-year-old man was diagnosed with influenza-associated invasive aspergillosis. Voriconazole therapy was initiated and adjusted to meet...
In this case report, a 49-year-old man was diagnosed with influenza-associated invasive aspergillosis. Voriconazole therapy was initiated and adjusted to meet therapeutic range. After 16 weeks of treatment the patient was admitted with multifocal, skeletal pains. Alkaline phosphatase was 1,900 U/L and S-voriconazole 9.9 mg/l. A bone scintigraphy and SPECT-CT were performed, and the diagnostic images along with the clinical findings were consistent with voriconazole-induced periostitis. Voriconazole therapy was discontinued, and isavuconazole therapy was initiated, and the patient's symptoms resolved completely.
Topics: Antifungal Agents; Humans; Male; Middle Aged; Periostitis; Voriconazole
PubMed: 31036146
DOI: No ID Found -
Journal of Clinical Rheumatology :... Apr 2022
Topics: Antifungal Agents; Humans; Periostitis; Pyrimidines; Voriconazole
PubMed: 35325905
DOI: 10.1097/RHU.0000000000001850 -
Journal of Pediatric Orthopedics 1994Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart disease. A significant and... (Review)
Review
Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart disease. A significant and unusual side effect of this drug treatment is the symmetrical development of periostitis of the long bones. A review of neonates with congenital heart disease requiring prostaglandin treatment at the Children's Hospital of Eastern Ontario revealed five infants who developed periostitis, the earliest onset being after 14 days of prostaglandin infusion. The drug dosage varied in these infants from 0.02 to 0.10 micrograms/kg/min. The periostitis was associated with limb pain and considerable swelling of the extremities in all children. The periostitis improved on cessation of the prostaglandin infusion, and by 6 weeks after the cessation of the drug, the periostitis had decreased significantly. Periostitis seemed more dependent on the duration of administration of the prostaglandin than on the dosage of prostaglandin administered. Awareness of this entity is essential not only for the treatment team caring for these infants but also for consultant pediatric orthopaedists to avoid excessive investigation for infection, metabolic disease, or vitamin deficiencies that resemble prostaglandin-induced periostitis.
Topics: Ductus Arteriosus, Patent; Female; Humans; Infant, Newborn; Male; Periostitis; Prostaglandins E; Radiography; Time Factors
PubMed: 7814600
DOI: 10.1097/01241398-199414060-00023 -
Journal of Oral and Maxillofacial... Sep 2017Periostitis ossificans, also known as Garré osteomyelitis, is a specific type of chronic osteomyelitis that forms new bone under the periosteum resulting from a... (Review)
Review
Periostitis ossificans, also known as Garré osteomyelitis, is a specific type of chronic osteomyelitis that forms new bone under the periosteum resulting from a periosteal reaction to chronic inflammation or infections. It commonly affects the mandible secondary to odontogenic infection. The therapeutic approach involves eliminating the infectious cause and antibiotic administration. This report describes an unusual case of periostitis ossificans arising from the mandible of an 11-year-old boy. The cause of infection was correlated with a lower right unerupted third molar, which had no obvious connection with the oral cavity. The histologic diagnosis was chronic osteomyelitis with proliferative periostitis. The patient has been followed for 1 year, without any evidence of recurrence. Periostitis ossificans can be diagnostically problematic, and various conditions must be considered in the differential diagnosis.
Topics: Biopsy; Child; Diagnosis, Differential; Diagnostic Imaging; Humans; Male; Mandibular Diseases; Molar, Third; Periostitis; Tooth Extraction; Tooth, Impacted
PubMed: 28527295
DOI: 10.1016/j.joms.2017.04.015 -
CMAJ : Canadian Medical Association... Oct 2015
Topics: Aged; Antifungal Agents; Female; Humans; Periostitis; Radiography; Voriconazole
PubMed: 26032311
DOI: 10.1503/cmaj.141025 -
Clinical Rheumatology Jul 2023
Topics: Humans; Voriconazole; Periostitis; Positron Emission Tomography Computed Tomography; Antifungal Agents; Positron-Emission Tomography
PubMed: 36811806
DOI: 10.1007/s10067-023-06547-2