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voriconazole periostitis

Miriam T Levine, Pranatharthi H Chandrasekar
Voriconazole use has increased since the drug's introduction in 2002, and new and unique adverse effects are emerging as patients undergo prolonged therapy. Most concerning is the increased risk of cutaneous malignancies, primarily squamous cell carcinoma (SCC); this risk is duration dependent and the associated malignancies tend to be more aggressive and multifocal. Voriconazole is also associated with phototoxicity (which may be a precursor to malignancy), periostitis, hallucinations and encephalopathy, peripheral neuropathy, alopecia, nail changes, hyponatremia, and other adverse effects...
September 1, 2016: Clinical Transplantation
Karen Sweiss, Annie Oh, Damiano Rondelli, Pritesh Patel
Voriconazole is an established first-line agent for treatment of invasive fungal infections in patients undergoing allogeneic stem cell transplantation (ASCT). It is associated with the uncommon complication of periostitis. We report this complication in a 58-year-old female undergoing HSCT. She was treated with corticosteroids with minimal improvement. The symptoms related to periostitis can mimic chronic graft-versus-host disease in patients undergoing HSCT and clinicians should differentiate this from other diagnoses and promptly discontinue therapy...
2016: Case Reports in Infectious Diseases
Marwan H Adwan
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...
July 4, 2016: Clinical Rheumatology
Joshua D Reber, Gavin A McKenzie, Stephen M Broski
Voriconazole-induced periostitis (VIP) is a rare but increasingly encountered entity since Food and Drug Administration (FDA) approval of the second generation antifungal medication in 2002. Literature reports most commonly include transplant recipients on immunosuppressive therapy simultaneously requiring antifungal therapy. Nontransplant patients receiving long-term voriconazole have an equal risk of developing the disease, but may experience a delay in diagnosis due to a lack of familiarity with the process outside of the post-transplant and/or immunosuppressed population...
June 2016: Skeletal Radiology
Megan R Barajas, Kristen B McCullough, Julianna A Merten, Ross A Dierkhising, Gabriel T Bartoo, Shahrukh K Hashmi, William J Hogan, Mark R Litzow, Mrinal M Patnaik, John W Wilson, Robert C Wolf, Robert A Wermers
Supportive care guidelines recommend antimold prophylaxis in hematopoietic stem cell transplant (HSCT) recipients deemed to have high risk for invasive fungal infection, leading to long-term use of voriconazole after allogeneic HSCT in patients who remain immunocompromised. Voriconazole has been associated with periostitis, exostoses, and fluoride excess in patients after solid organ transplantation, HSCT, and leukemia therapy. The aims of this study were to describe the frequency and clinical presentation of patients presenting with pain and fluoride excess among allogeneic HSCT patients taking voriconazole, to identify when a plasma fluoride concentration was measured with respect to voriconazole initiation and onset of pain, and to describe the outcomes of patients with fluoride excess in the setting of HSCT...
March 2016: Biology of Blood and Marrow Transplantation
M Rheinboldt, Z Delproposto, R Agarwal
Voriconazole, first commercially approved in 2002 as a second-generation antifungal agent, is commonly used in the immunocompromised setting as both a therapeutic and prophylactic agent. Since 2009, scattered case reports and small case series have detailed a secondary drug-related hyperfluorosis-induced painful periostitis that can occur in the treated patient population. We present a pictorial review of the thoracic imaging manifestations utilizing 3 illustrative cases in the setting of both solid organ and bone marrow transplantation...
December 2015: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Kahtonna C Allen, Carlos J Sanchez, Krista L Niece, Joseph C Wenke, Kevin S Akers
Periostitis, which is characterized by bony pain and diffuse periosteal ossification, has been increasingly reported with prolonged clinical use of voriconazole. While resolution of clinical symptoms following discontinuation of therapy suggests a causative role for voriconazole, the biological mechanisms contributing to voriconazole-induced periostitis are unknown. To elucidate potential mechanisms, we exposed human osteoblasts in vitro to voriconazole or fluconazole at 15 or 200 μg/ml (reflecting systemic or local administration, respectively), under nonosteogenic or osteogenic conditions, for 1, 3, or 7 days and evaluated the effects on cell proliferation (reflected by total cellular DNA) and osteogenic differentiation (reflected by alkaline phosphatase activity, calcium accumulation, and expression of genes involved in osteogenic differentiation)...
December 2015: Antimicrobial Agents and Chemotherapy
Sunita Paudyal, Stephen Dummer, Prabhakar Battu, Sylvester Taylor, Saroj Sharma, Laura Carbone
No abstract text is available yet for this article.
December 2015: Arthritis & Rheumatology
Derik L Davis
Painful periostitis is a complication of long-term antifungal therapy with voriconazole. A high clinical suspicion coupled with imaging and laboratory assessment is useful to establish the diagnosis. Prompt discontinuance of voriconazole typically results in the resolution of symptoms and signs. This report describes the presentation of voriconazole-related periostitis on magnetic resonance imaging.
January 2015: Clinical Cases in Mineral and Bone Metabolism
Tetiana Glushko, Inés Colmegna
No abstract text is available yet for this article.
October 6, 2015: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Tina D Tailor, Michael L Richardson
History A 74-year-old woman presented with multifocal bone pain, including pain in multiple ribs, bilateral shoulders, and bilateral hips. The pain began several months before presentation and was quite severe, ultimately necessitating control with narcotics. At examination, strength in both lower extremities was slightly reduced, sensation and reflexes were intact, and range of motion was full, though painful. There were no notable constitutional symptoms of fever or weight loss. Laboratory work-up was remarkable for elevated alkaline phosphatase level (277 U/L [4...
March 2015: Radiology
John H Baird, Belinda K Birnbaum, David L Porter, Noelle V Frey
No abstract text is available yet for this article.
June 2015: American Journal of Hematology
Babak Rad, Mohamed Saleem, Susan Grant, Christopher Florkowski, Penelope Coates, David Gordon, Wayne Rankin
We describe a case of development of painful periostitis deformans in a 39-year-old woman who was receiving long-term voriconazole treatment for Aspergillus infection as a complication of orthotopic liver transplant. Measurement of fluoride levels strongly supports fluorosis to be the mechanism of the voriconazole-induced periostitis deformans and supports the concept that such measurements might be of use in predicting this complication of long-term voriconazole treatment.
September 2015: Annals of Clinical Biochemistry
Margaret Skaug, Cedric Spak, Umesh Oza
A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis.
October 2014: Proceedings of the Baylor University Medical Center
Katherine Tarlock, Darren Johnson, Cathy Cornell, Shawn Parnell, Soheil Meshinchi, K Scott Baker, Janet A Englund
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...
May 2015: Pediatric Blood & Cancer
Woo J Moon, Erica L Scheller, Anupam Suneja, Jacob A Livermore, Anurag N Malani, Varsha Moudgal, Lisa E Kerr, Eric Ferguson, David M Vandenberg
BACKGROUND: Voriconazole is a triazole antifungal medication used for prophylaxis or to treat invasive fungal infections. Inflammation of the periosteum resulting in skeletal pain, known as periostitis, is a reported side effect of long-term voriconazole therapy. The trifluorinated molecular structure of voriconazole suggests a possible link between excess fluoride and periostitis, as elevated blood fluoride has been reported among patients with periostitis who received voriconazole. METHODS: Two hundred sixty-four patients from Michigan were impacted by the multistate outbreak of fungal infections as a result of contaminated methylprednisolone injections...
November 1, 2014: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Meera Raghavan, Alex Hayes
Voriconazole-related periostitis has been increasingly described in the literature over the last several years as a recognizable disease entity, especially in lung transplant patients. This relationship should be considered when approaching immunosuppressed patients presenting with diffuse bone pain and imaging findings of periostitis. We present a case of voriconazole-associated periostitis, capsular and enthesial ossification and glenuhumeral capsulitis in a patient with a hematologic malignancy. To the authors' knowledge, soft tissue ossification associated with voriconazole has not been described in the radiology literature...
September 2014: Skeletal Radiology
Keisho Hirota, Akihiro Yasoda, Toshihito Fujii, Nobuya Inagaki
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...
2014: BMJ Case Reports
Matthew D Bucknor, Andrew J Gross, Thomas M Link
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...
August 2013: Journal of Radiology Case Reports
Heather S Gladue, David A Fox
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...
December 2013: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
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