Case 215: voriconazole-induced periostitis.

Journal Article (Journal Article)

History A 74-year-old woman presented with multifocal bone pain, including pain in multiple ribs, bilateral shoulders, and bilateral hips. The pain began several months before presentation and was quite severe, ultimately necessitating control with narcotics. At examination, strength in both lower extremities was slightly reduced, sensation and reflexes were intact, and range of motion was full, though painful. There were no notable constitutional symptoms of fever or weight loss. Laboratory work-up was remarkable for elevated alkaline phosphatase level (277 U/L [4.6 mkat/L]). The patient had undergone left lung transplantation 8 years prior for pulmonary fibrosis. A thorough pulmonary work-up for the cause of fibrosis, which included gathering an exposure, occupational, allergy, and previous infectious history, and a rheumatoid work-up were negative. The patient's posttransplantation course was complicated by bronchiolitis obliterans from chronic rejection and by recent pulmonary embolism, for which she was undergoing anticoagulation therapy at the time of presentation. Additionally, the patient experienced repeated pulmonary infections with Aspergillus, leading to multiple hospitalizations and long-term antifungal prophylaxis with voriconazole. A bone scan from an outside hospital was reviewed, and further imaging was performed.

Full Text

Duke Authors

Cited Authors

  • Tailor, TD; Richardson, ML

Published Date

  • March 2015

Published In

Volume / Issue

  • 274 / 3

Start / End Page

  • 930 - 935

PubMed ID

  • 25710343

Electronic International Standard Serial Number (EISSN)

  • 1527-1315

Digital Object Identifier (DOI)

  • 10.1148/radiol.14122800


  • eng

Conference Location

  • United States