Voriconazole-induced periostitis: a new rheumatic disorder

Over the past few years, several reports of periostitis affecting patients treated with voriconazole appeared in the literature. As rheumatologists are likely to be called to see such patients, a review of the reported cases was undertaken. A systematic search of Pubmed and Google scholar for case reports, case series and observational studies was undertaken. Twenty-six articles including 23 case reports/case series (total 40 patients), a prospective study and two retrospective studies of 58 cases were included. Age ranged from 3 months to 77 years. Eleven cases (27.5 %) were male and 29 cases (72.5 %) were female. The duration of treatment varied from 6 weeks to 8 years (mean 53.6, SD 77.4 weeks). Most cases presented with diffuse skeletal pain affecting various sites in association with elevated alkaline phosphatase. Periostitis is increasingly reported and should be considered in patients taking voriconazole who present with bone pain and/or alkaline phosphatase elevation.