Question - A patient receiving long term antifungal prophylactic therapy, post- lung transplantation, presents with bilateral hand pain with x-rays that reveal “dense, irregular, nodular periostitis of the bones of both hands and wrists”. What drug is the likely cause of these findings?
Answer - The drug that likely caused these effects is voriconazole. The cited article notes “Voriconazle is a trifluorinated antifungal medication; the mechanism of the periostitis is thought to be related to the effects of fluoride on bone.” (Hedrick J and Droz N. Voriconazole-induced periostitis. 2019 NEJM 381:15 and Tan I et al. Spectrum of voriconazole-induced periostitis with review of the differential diagnosis. 2019 AJR 212(1):157-165)
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