Thoracic periosteal reaction secondary to voriconazole use in an adult transplant patient

Anisha N Shetty; Kristopher W Cummings; Michael B Gotway; Eric A Jensen; Clinton E Jokerst; Prasad M Panse; Carlos A Rojas

doi:10.1016/j.radcr.2023.10.010

Thoracic periosteal reaction secondary to voriconazole use in an adult transplant patient

Radiol Case Rep. 2023 Nov 9;19(1):346-348. doi: 10.1016/j.radcr.2023.10.010. eCollection 2024 Jan.

Authors

Anisha N Shetty¹, Kristopher W Cummings¹, Michael B Gotway¹, Eric A Jensen¹, Clinton E Jokerst¹, Prasad M Panse¹, Carlos A Rojas¹

Affiliation

¹ Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054 USA.

Abstract

Periosteal reaction may result from multiple causes including infection, trauma, medications, and neoplasms. One important etiology that must be considered in the differential diagnosis of symmetric periosteal reaction, especially in immunocompromised patients, is voriconazole use. We present a case of a 65-year-old man who underwent liver transplantation complicated by acute hypoxic respiratory failure and Aspergillus infection. Long term voriconazole therapy was initiated with resultant development of thoracic periosteal reaction which improved following discontinuation of the medication. Given the preferential upper body distribution of periosteal reaction induced by voriconazole, chest radiologists might be the first ones to recognize this adverse effect.

Keywords: CT; Periosteal reaction; Periostitis; Thorax; Voriconazole.

Publication types

Case Reports