ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2014
Plasma fluoride level as a predictor of voriconazole-induced periostitis in patients with skeletal pain.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02955966 (PET/CT Guided Antifungal Stewardship in Invasive Pulmonary Aspergillosis), which is not on this map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
PET/CT Guided Antifungal Stewardship in Invasive Pulmonary Aspergillosis
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.
- Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Fluoride Pharmacokinetics in Urine and Plasma Following Multiple Doses of MK-8507, an Investigational, Oral, Once-Weekly Nonnucleoside Reverse Transcriptase Inhibitor.Journal of clinical pharmacology · 2022Trial
- A Phase 1 Trial to Evaluate the Relationship Between Fluoride Intake and Urinary Fluoride Excretion in Healthy Participants.Journal of clinical pharmacology · 2022Trial
- Isavuconazole Treatment of Cryptococcosis and Dimorphic Mycoses.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Trial
- Incidence of Voriconazole-induced periostitis in a tertiary medical center: a single-center retrospective analysis.BMC infectious diseases · 2026Article
- Voriconazole-induced periostitis in the hand.Radiology case reports · 2025Article
- Associations of cumulative voriconazole dose, treatment duration, and alkaline phosphatase with voriconazole-induced periostitis.Skeletal radiology · 2025Article
- Voriconazole-Induced Periostitis: A Mimicker of Skeletal Coccidioidomycosis.The American journal of case reports · 2024Article
- Voriconazole-induced periostitis in a patient with HIV treated for coccidioidomycosis meningitis.BMJ case reports · 2024Article
- Thoracic periosteal reaction secondary to voriconazole use in an adult transplant patient.Radiology case reports · 2024Article
- Using disproportionality analysis to explore the association between periostitis and triazole antifungals in the FDA Adverse Event Reporting System Database.Scientific reports · 2023Article
- Systemic Antifungal Therapy for Invasive Pulmonary Infections.Journal of fungi (Basel, Switzerland) · 2023Review
- Spectrum of voriconazole-associated periostitis in clinical characteristics, diagnosis and management.Infection · 2022Article
- Voriconazole-induced periostitis post lung transplantation.Radiology case reports · 2022Article
- Voriconazole-Associated Periostitis: New Insights into Pathophysiology and Management.JBMR plus · 2022Article
- Safety of triazole antifungals: a pharmacovigilance study from 2004 to 2021 based on FAERS.Therapeutic advances in drug safety · 2022Article
- Striking Back against Fungal Infections: The Utilization of Nanosystems for Antifungal Strategies.International journal of molecular sciences · 2021Review
- Voriconazole-associated periostitis: Pathophysiology, risk factors, clinical manifestations, diagnosis, and management.World journal of transplantation · 2021Review
- Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients.Journal of fungi (Basel, Switzerland) · 2021Review
- Article
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundVoriconazole 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.
methodsTwo hundred sixty-four patients from Michigan were impacted by the multistate outbreak of fungal infections as a result of contaminated methylprednisolone injections. A retrospective study was conducted among 195 patients who received voriconazole therapy at St Joseph Mercy Hospital during this outbreak. Twenty-eight patients who received both bone scan and plasma fluoride measurements for skeletal pain were included in the statistical analyses. Increased tracer uptake on bone scan was considered positive for periostitis. The primary outcome measure was the correlation between plasma fluoride and bone scan results.
resultsBlood fluoride (P < .001), alkaline phosphatase (P = .020), daily voriconazole dose (P < .001), and cumulative voriconazole dose (P = .027) were significantly elevated in patients who had periostitis compared with those who did not. Discontinuation or dose reduction of voriconazole resulted in improvement of pain in 89% of patients.
conclusionsHigh plasma fluoride levels coupled with skeletal pain among patients who are on long-term voriconazole therapy is highly suggestive of periostitis. Initial measurement of fluoride may be considered when bone scan is not readily available. Early detection should be sought, as discontinuation of voriconazole is effective at reversing the disease.
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