JBMR Plus
(Feb 2022)
Voriconazole‐Associated Periostitis: New Insights into Pathophysiology and Management
- Michael J Bennett,
- Matthew I Balcerek,
- Edward AD Lewis,
- Roland LL Zhang,
- Caroline Bachmeier,
- Siok Tey,
- Steven Faux,
- Laila Girgis,
- Jerry R Greenfield,
- Syndia Lazarus
Affiliations
- Michael J Bennett
- Department of Endocrinology and Diabetes St Vincent's Hospital Darlinghurst Australia
- Matthew I Balcerek
- Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital Herston Australia
- Edward AD Lewis
- Department of Rehabilitation Sacred Heart Health Service, St Vincent's Hospital Darlinghurst Australia
- Roland LL Zhang
- Heart and Lung Transplant Unit St Vincent's Hospital Darlinghurst Australia
- Caroline Bachmeier
- Chemical Pathology Pathology Queensland, Royal Brisbane and Women's Hospital Herston Australia
- Siok Tey
- Department of Haematology and Bone Marrow Transplantation Royal Brisbane and Women's Hospital Herston Australia
- Steven Faux
- Department of Rehabilitation Sacred Heart Health Service, St Vincent's Hospital Darlinghurst Australia
- Laila Girgis
- Department of Rheumatology St Vincent's Hospital Darlinghurst Australia
- Jerry R Greenfield
- Department of Endocrinology and Diabetes St Vincent's Hospital Darlinghurst Australia
- Syndia Lazarus
- Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital Herston Australia
- DOI
-
https://doi.org/10.1002/jbm4.10557
- Journal volume & issue
-
Vol. 6,
no. 2
pp.
n/a
– n/a
Abstract
Read online
ABSTRACT Voriconazole‐associated periostitis (VAP) is an underrecognized and unpredictable side effect of long‐term voriconazole therapy. We report two cases of VAP occurring in the post‐transplant setting: a 68‐year‐old lung transplant recipient who required ongoing voriconazole therapy, in whom urinary alkalinization was used to promote fluoride excretion and minimize voriconazole‐related skeletal toxicity, and a 68‐year‐old stem‐cell transplant recipient with a high voriconazole dose requirement, identified on pharmacogenomic testing to be a CYP2C19 ultrarapid metabolizer, the dominant enzyme in voriconazole metabolism. This is the first reported case of pharmacogenomic profiling in VAP and may explain the variability in individual susceptibility to this uncommon adverse effect. Our findings provide new insights into both the management and underlying pathophysiology of VAP. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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