CTICasesVoriconazole-Induced Skeletal Fluorosis
Imaging findings
A man with severe chronic sarcoidosis and extensive upper lobe end-stage fibrosis developed an aspergilloma in a left upper lobe cavity and was started on voriconazole. Over about two years of therapy, the bones became markedly denser, simulating renal osteodystrophy, with periostitis and periosteal new bone. He has no renal insufficiency.
Key takeaways
Long-term voriconazole therapy causes hyperfluorosis from increased fluoride retention, producing diffusely dense bones and periostitis that can closely mimic renal osteodystrophy. The associated periostitis and periosteal new bone (and sometimes painful hyperostosis) help distinguish it from renal osteodystrophy, and recognition is important in patients on prolonged antifungal therapy for cavitary aspergillus disease.
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