ArticleInfection2022
Spectrum of voriconazole-associated periostitis in clinical characteristics, diagnosis and management.
Article in Infection, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 6 citations in OpenAlex.
- Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review.BMC musculoskeletal disorders · 2025Review
- Voriconazole-Induced Periostitis: A Mimicker of Skeletal Coccidioidomycosis.The American journal of case reports · 2024Article
- Bilateral leg pain and swelling with abnormal imaging findings in a patient with voriconazole.The Korean journal of internal medicine · 2024Article
- Voriconazole-induced periostitis in a patient with HIV treated for coccidioidomycosis meningitis.BMJ case reports · 2024Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
purposePrevious knowledge about the relationship between voriconazole exposure and periostitis was mainly based on limited case reports and few retrospective studies. The purpose of this study was to assess the clinical characteristics, diagnosis and management of voriconazole-associated periostitis.
methodsCase reports and case series from 1998 to November 30, 2021 on periostitis induced by voriconazole were collected for retrospective analysis.
resultsForty four patients (18 male and 26 female) from 34 studies were included in total. The median age was 58 years (29-74). The majority of patients had undergone organ transplantation (50.0%) or suffered from hematologic malignancy (31.81%). The median onset time of symptoms was 6 months after the start of voriconazole. The most common initial symptom was diffuse skeletal pain (68.28%) which can be severe and even disabling (66.7%). Ribs (37.21%), femurs (32.56%), scapulae (25.58%), humerus (23.26%), and clavicle (23.26%) were the common involved locations. Most cases were accompanied by different degrees of elevated serum alkaline phosphatase and fluoride level, while some presented with elevated bone-specific alkaline phosphatase. The main radiological features included periosteal reaction and multifocal high radiotracer uptake on bone scintigraphy. The formation of new bone was characterized with bilateral, irregular, nodular, as well as high density. The resolution of symptoms was observed with discontinuation of voriconazole in all patients, of whom 18 patients (52.94%) were relieved within a week. Itraconazole, posaconazole or isavuconazole were safe alternatives to voriconazole in voriconazole-induced periostitis.
conclusionVoriconazole-induced periostitis is an infrequent complication characterized by bone inflammation involving one or multiple skeletal areas. Bony pain, elevated serum alkaline phosphatase as well as fluoride level are suspicious signs during voriconazole treatment.
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