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voriconazole periostitis

Krishna Poinen, Marianna Leung, Alissa Jade Wright, David Landsberg
BACKGROUND: Immunosuppression increases the risk of opportunistic infections including fungal infections in solid organ transplant recipients. Voriconazole is used to treat invasive aspergillus infections but prolonged usage may rarely lead to periostitis. Increased plasma fluoride concentration leading to osteoblastic upregulation is thought to be the catalyst, and symptom reversal occurs with discontinuation of the offending agent. CASE: A renal transplant recipient who was on voriconazole for invasive aspergillosis developed diffuse debilitating symmetrical bone pain...
June 5, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Shakir Hussain
Periostitis deformans is an uncommon condition of the skeletal system, mainly manifested as bone pain with or without bony swellings. Voriconazole-induced periostitis is widely reported in the literature, mainly in the organ transplant patients on immunosuppressant therapy. The patient in this case report, was not on any immunosuppressant therapy, but developed widespread periostitis deformans secondary to voriconazole, who was being treated for the base of skull aspergillus osteomyelitis. This report demonstrates the severity of voriconazole adverse effects and the wider impact on patient...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
S Cormican, N Adams, P O'Connell, A McErlean, D de Freitas
The original version of this paper unfortunately contained mistakes in the affiliations for all authors.
April 2018: Skeletal Radiology
Maria Jesús Gayán Belmonte, Carmen María Botía González, Almudena García Gerónimo, Margarita Martínez Fernández, Isabel María González Moreno
No abstract text is available yet for this article.
January 9, 2018: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
S Cormican, N Adams, P O'Connell, A McErlean, D de Freitas
OBJECTIVES: A 61-year-old with acute granulomatosis and polyangiitis developed Aspergillus fumigatus pneumonia after admission to the intensive care unit with a small bowel perforation. This occurred after immunosuppression (intravenous methylprednisolone, intravenous cyclophosphamide, and plasmapheresis) for his initial presentation with stage 3 acute kidney injury. MATERIALS AND METHODS: The mycologist recommended long-term treatment with voriconazole after initial recovery...
February 2018: Skeletal Radiology
Karim Ladak, Laurence Rubin
No abstract text is available yet for this article.
June 2017: Clinical Medicine & Research
Monica Sircar, Camille Kotton, David Wojciechowski, Kassem Safa, Hannah Gilligan, Eliot Heher, Winfred Williams, Ravi Thadhani, Nina Tolkoff-Rubin
BACKGROUND: Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. AIM: Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. CASE PRESENTATION: Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections...
November 2016: Journal of Biosciences and Medicines
Felix Y Yap, Matthew R Skalski, Dakshesh B Patel, Aaron J Schein, Eric A White, Anderanik Tomasian, Sulabha Masih, George R Matcuk
Hypertrophic osteoarthropathy (HOA) is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, known as pachydermoperiostosis, or can be secondary to extraskeletal conditions, with different prognoses and management implications for each. There is a high association between secondary HOA and malignancy, especially non-small cell lung cancer...
January 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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...
November 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...
March 2017: 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
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