Mimicking Multiple Myeloma: Voriconazole-Induced Hyperfluorosis and Bone Lesions
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Voriconazole is one of the triazoles, which are the mainstay of therapy for disseminated coccidioidomycosis infections. Chronic voriconazole use has been associated with elevated serum levels of fluoride and skeletal disease. Bony changes resemble periostitis deformans, a condition associated with drinking excessively fluoridated water1, 2, 3. Additionally, voriconazole is believed to cause bony changes in a non-fluoride mediated pathway via osteoblast activation and stimulation of cytokine release4. In our patient, voriconazole was replaced with posaconazole and he experienced significant improvement within weeks of this change.
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Conflict of Interest
The authors have no conflicts of interest to disclose and have received no financial support for this project.
- 1.Thompson GR, 3rd, Bays D, Cohen SH, Pappagianis D. Fluoride excess in coccidioidomycosis patients receiving long-term antifungal therapy: an assessment of currently available triazoles. Antimicrob Agents Chemother 2012;56(1):563-4 doi: https://doi.org/10.1128/AAC.05275-11.CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Moon WJ, Scheller EL, Suneja A, Livermore JA, Malani AN, Moudgal V, Kerr LE, Ferguson E, Vandenberg DM. Plasma fluoride level as a predictor of voriconazole-induced periostitis in patients with skeletal pain. Clin Infect Dis 2014;59(9):1237-45 doi: https://doi.org/10.1093/cid/ciu513.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Allen KC, Sanchez CJ, Jr., Niece KL, Wenke JC, Akers KS. Voriconazole Enhances the Osteogenic Activity of Human Osteoblasts In Vitro through a Fluoride-Independent Mechanism. Antimicrob Agents Chemother 2015;59(12):7205-13 doi: https://doi.org/10.1128/AAC.00872-15.CrossRefPubMedPubMedCentralGoogle Scholar