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Skeletal Radiology

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01-02-2018 | Scientific Article

Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis

Authors: S. Cormican, N. Adams, P. O’Connell, A. McErlean, D. de Freitas

Published in: Skeletal Radiology | Issue 2/2018

Abstract

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.

Results

After 7 months of treatment, the patient complained of joint pain and swelling in his hands. Radiographs, computed tomography, and single-photon emission computed tomography appearances were consistent with periostitis. A diagnosis of Voriconazole-induced periostitis deformans was made and the voriconazole was stopped. Plasma fluoride level was 278 μg/L (normal range < 50 μg/L). Discontinuation of voriconazole led to clinical improvement.

Conclusions

Periostitis deformans due to fluorosis is a rare complication of voriconazole treatment. The imaging in our case is unusually dramatic. We were able to track the evolution of periosteal reactions over serial imaging.

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Title: Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis
Authors: S. Cormican
N. Adams
P. O’Connell
A. McErlean
D. de Freitas
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Skeletal Radiology / Issue 2/2018
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-017-2764-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis

Abstract

Objectives

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

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