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Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis
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Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis
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Journal Article
Voriconazole-induced periostitis deformans: serial imaging in a patient with ANCA vasculitis
2018
Overview
ObjectivesA 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 methodsThe mycologist recommended long-term treatment with voriconazole after initial recovery.ResultsAfter 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.ConclusionsPeriostitis 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.
Publisher
Springer Nature B.V
