Voriconazole-Induced Periostitis & Enthesopathy in Solid Organ Transplant Patients: Case Reports.
J Biosci Med (Irvine)
; 4(11): 8-17, 2016 Nov.
Article
em En
| MEDLINE
| ID: mdl-27990445
ABSTRACT
BACKGROUND:
Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis.AIM:
Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. CASE PRESENTATION Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes.CONCLUSIONS:
Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase, voriconazole trough and fluoride levels as well as a bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
J Biosci Med (Irvine)
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Estados Unidos