Voriconazole-Induced Periostitis &Enthesopathy in Solid Organ Transplant Patients: Case Reports  

作　　者：Monica Sircar Camille Kotton David Wojciechowski Kassem Safa Hannah Gilligan Eliot Heher Winfred Williams Ravi Thadhani Nina Tolkoff-Rubin Monica Sircar;Camille Kotton;David Wojciechowski;Kassem Safa;Hannah Gilligan;Eliot Heher;Winfred Williams;Ravi Thadhani;Nina Tolkoff-Rubin(Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA;Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA;MGH Transplant Center, Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, MA, USA)

机构地区：[1]Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA [2]Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA [3]MGH Transplant Center, Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, MA, USA

出　　处：《Journal of Biosciences and Medicines》2016年第11期8-17,共11页生物科学与医学（英文）

摘　　要：Background: Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Aim: Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Case Presentation: Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes. Conclusions: Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase and fluoride levels, voriconazole trough and bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes.Background: Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Aim: Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Case Presentation: Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes. Conclusions: Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase and fluoride levels, voriconazole trough and bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes.

关 键 词：VORICONAZOLE PERIOSTITIS Organ Transplant ENTHESOPATHY Drug Metabolism 

分 类 号：R97[医药卫生—药品]