CTICasesVoriconazole-Induced Periostitis
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Imaging findings
High-resolution chest CT shows exuberant, nodular, and diffuse periosteal reaction predominantly affecting the ribs, clavicles, scapulae, and proximal humeri, while the underlying bone marrow remains normal. This represents a significant progression from a scan performed one year prior, during which only minimal linear periosteal reaction was visible.
Key takeaways
Long-term voriconazole therapy, typically for over a year as seen in this patient treated for aspergillus infection, can lead to painful, debilitating periostitis. The mechanism is believed to be fluoride toxicity, as voriconazole contains multiple fluoride atoms. Switching the patient to another azole antifungal, such as posaconazole, typically resolves the symptoms and causes the periosteal reaction to regress.
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