{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T20:50:06Z","timestamp":1757451006353,"version":"3.41.2"},"reference-count":14,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T00:00:00Z","timestamp":1529625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Immunosuppression increases the risk of opportunistic infections including fungal infections in solid organ transplant recipients. Voriconazole is used to treat invasive aspergillus infections but prolonged usage may rarely lead to periostitis. Increased plasma fluoride concentration leading to osteoblastic upregulation is thought to be the catalyst, and symptom reversal occurs with discontinuation of the offending agent. A renal transplant recipient who was on voriconazole for invasive aspergillosis developed diffuse debilitating symmetrical bone pain. Having ruled out other neurological, metabolic, and drug etiologies, voriconazole\u2010induced periostitis was diagnosed. Increased plasma fluoride level was documented, but bone scan was non\u2010specific. A therapeutic discontinuation of voriconazole and switch to posaconazole provided rapid symptom resolution. The patient accidently restarted voriconazole as an outpatient resulting in the same symptomology, and thus provided further evidence that this was drug related. Voriconazole\u2010induced periostitis is a described entity in immunosuppressed solid organ transplant patients who are treated with a prolonged course of voriconazole. This case study is novel in that it demonstrates drug induced periostitis in a renal transplant recipient who developed debilitating periostitis within a short time after starting voriconazole and equally rapid resolution once it was discontinued. We conclude that patients treated with voriconazole should be routinely monitored for periostitis.<\/jats:p>","DOI":"10.1111\/tid.12941","type":"journal-article","created":{"date-parts":[[2018,6,6]],"date-time":"2018-06-06T06:37:51Z","timestamp":1528267071000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A vexing case of bone pain in a renal transplant recipient: Voriconazole\u2010induced periostitis"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0118-0280","authenticated-orcid":false,"given":"Krishna","family":"Poinen","sequence":"first","affiliation":[{"name":"Department of Nephrology University of British Columbia  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Pharmacy St. Paul's Hospital Providence Healthcare  Vancouver BC Canada"},{"name":"Faculty of Pharmaceutical Sciences University of British Columbia  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alissa Jade","family":"Wright","sequence":"additional","affiliation":[{"name":"Transplant Infectious Disease Program Division of Infectious Disease University of British Columbia  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Landsberg","sequence":"additional","affiliation":[{"name":"Transplant Program Department of Nephrology St. Paul's Hospital Providence Healthcare  Vancouver BC Canada"},{"name":"BC Transplant Society  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.14740\/jocmr2104w"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2006.06.001"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02837.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20110922-35"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-010-0997-y"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq188"},{"key":"e_1_2_7_9_1","first-page":"8","article-title":"Voriconazole\u2010induced periostitis & enthesopathy in solid organ transplant patients: case reports","volume":"4","author":"Sircar M","year":"2016","journal-title":"J Biosci Med"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-01-403030"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.14122800"},{"key":"e_1_2_7_12_1","first-page":"10","article-title":"Voriconazole\u2010induced periostitis in two post\u2010transplant patients","volume":"7","author":"Bucknor MD","year":"2013","journal-title":"Musculoskelet Radiol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34618"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/651262"},{"key":"e_1_2_7_15_1","unstructured":"Naranjo Scale Online Calculator.http:\/\/farmacologiaclinica.info\/scales\/Naranjo_scale\/. Accessed September 13 2017."}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.12941","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.12941","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T04:11:07Z","timestamp":1694837467000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.12941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,22]]},"references-count":14,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1111\/tid.12941"],"URL":"https:\/\/doi.org\/10.1111\/tid.12941","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"type":"print","value":"1398-2273"},{"type":"electronic","value":"1399-3062"}],"subject":[],"published":{"date-parts":[[2018,6,22]]},"assertion":[{"value":"2018-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12941"}}