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Voriconazole-induced periostitis is an important etiology of painful diffuse periostitis in immunocompromised patients characterized by dense, irregular, diffuse periostitis and increased uptake on Tc-99m MDP whole body bone scans. Clinicians and radiologists should carefully correlate with the clinical history in the setting of diffuse bony changes, particularly in immunocompromised patients.






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Voriconazole-induced periostitis in two post-transplant patients

Free full text article: Voriconazole-induced periostitis  in two post-transplant patients

Abstract
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. Case 1 features a 60 year-old woman with a history of orthotopic heart transplant who was hospitalized for "full body pain" with progressively worsening bone tenderness involving the humeri, knees, femurs, hips, and hands. Case 2 describes a 48 year-old man with a history of acute lymphoblastic leukemia status post stem cell transplant who presented with diffuse arthralgias involving bilateral ankles, knees, wrists, and elbows.






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