Voriconazole-induced arthritis, enthesitis and periostitis

IF 0.4 Q3 MEDICINE, GENERAL & INTERNAL Proceedings of Singapore Healthcare Pub Date : 2023-01-03 DOI:10.1177/20101058221149575
A. Masnammany, Wendy Lau, P. Wong, N. Manolios
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Abstract

Voriconazole is a fluoride-containing anti-fungal. Prolonged exposure can result in fluoride deposition within the bone extracellular matrix, resulting in periostitis and arthritis. We report a patient who developed widespread bony pain and polyarthralgia while on voriconazole therapy for COVID-19-associated pulmonary aspergillosis. No associated autoimmune rheumatic disease or alternative cause was noted. Blood investigations showed elevated total serum alkaline phosphatase, bone-specific ALP and fluoride levels, with normal serum voriconazole levels. A whole body nuclear bone scan showed multifocal periostitis. A diagnosis of voriconazole-induced periostitis and arthritis was made. Complete resolution of clinical symptoms with normalisation of the serum ALP occurred within four weeks of voriconazole cessation. While voriconazole-induced periostitis/arthritis is a recognised phenomenon in solid organ and haematopoietic stem cell transplant patients on long-term voriconazole, this case highlights the importance of having a high index of suspicion in other settings including CAPA. Clinical presentation can be mistaken for bony metastatic disease or other inflammatory arthritis.
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伏立康唑引起的关节炎、附着点炎和骨膜炎
伏立康唑是一种含氟的抗真菌药物。长期暴露会导致氟沉积在骨细胞外基质中,导致骨膜炎和关节炎。我们报告了一名患者,他在接受伏立康唑治疗COVID-19相关肺曲膜炎时出现广泛的骨痛和多关节痛。没有发现相关的自身免疫性风湿性疾病或其他原因。血液检查显示血清总碱性磷酸酶、骨特异性碱性磷酸酶和氟化物水平升高,血清伏立康唑水平正常。全身核骨扫描显示多灶性骨膜炎。诊断为伏立康唑引起的骨膜炎和关节炎。伏立康唑停用后四周内,临床症状完全缓解,血清ALP正常化。虽然伏立康唑诱导的骨膜炎/关节炎在长期服用伏立康唑的实体器官和造血干细胞移植患者中是一种公认的现象,但该病例突出了在包括CAPA在内的其他情况下具有高怀疑指数的重要性。临床表现可能被误认为是骨转移性疾病或其他炎性关节炎。
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来源期刊
Proceedings of Singapore Healthcare
Proceedings of Singapore Healthcare MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
42
审稿时长
15 weeks
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