Voriconazole-associated periostitis: Pathophysiology, risk factors, clinical manifestations, diagnosis, and management

Figure 1 Whitish specks and discoloration, evidence of dental fluorosis, noted on the patient’s teeth.

Figure 2 X-ray of bones showed evidence of skeletal fluorosis. A: Periosteal elevation (arrows) on the left clavicle and proximal left humerus; B: Fluffy periostitis (arrows) on the right humerus; and C: Periosteal reaction (arrows) on the proximal left femur.

Figure 3 Whole body nuclear bone scan. Increased radiotracer uptake (bright white spots) on clavicles, humeri, and femurs (A), as well as feet (B).

Figure 4 Chemical structures of triazole antifungal medications (fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole). “F” stands for fluorine atom (with permission and courtesy from Dr. Harrold, Division of Pharmaceutical, Administrative and Social Sciences; Duquesne University School of Pharmacy).