Open AccessVoriconazole‐Associated Periostitis: New Insights into Pathophysiology and Management
Author(s) -
Bennett Michael J,
Balcerek Matthew I,
Lewis Edward AD,
Zhang Roland LL,
Bachmeier Caroline,
Tey Siok,
Faux Steven,
Girgis Laila,
Greenfield Jerry R,
Lazarus Syndia
Publication year - 2022
Publication title -
jbmr plus
Language(s) - English
Resource type - Journals
ISSN - 2473-4039
DOI - 10.1002/jbm4.10557
Subject(s) - voriconazole , medicine , intensive care medicine , periostitis , pharmacogenomics , pharmacology , pathology , dermatology , antifungal
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.