Spectrum of Voriconazole-Induced Periostitis With Review of the Differential Diagnosis

AJR Am J Roentgenol. 2019 Jan;212(1):157-165. doi: 10.2214/AJR.18.19991. Epub 2018 Nov 7.

Abstract

Objective: Voriconazole is an antifungal medication used primarily for the treatment of Candida and Aspergillus infections. A fairly newly described side effect of long-term voriconazole use is periostitis. The purpose of this article is to describe the main differential consideration-hypertrophic osteoarthropathy-and other differential diagnoses, including venous stasis, thyroid acropachy, and hypervitaminosis A.

Conclusion: With knowledge of imaging appearance, clinical manifestations, and outcomes, radiologists can make an accurate diagnosis of voriconazole-induced periostitis, and clinical teams can initiate appropriate management.

Keywords: fluorosis; hypertrophic osteoarthropathy; hypervitaminosis A; periostitis; thyroid acropachy; venous stasis; voriconazole.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / adverse effects*
  • Diagnosis, Differential
  • Humans
  • Periostitis / chemically induced*
  • Periostitis / diagnostic imaging*
  • Voriconazole / adverse effects*

Substances

  • Antifungal Agents
  • Voriconazole