Contributions
Abstract: PB2064
Type: Publication Only
Background
Voriconazole is commonly used antifungal agent used in paediatric oncology patients for prophylaxis and treatment of fungal infections. We report here on one of our post transplant patients who presented with acute bone pain over the tibia.
Aims
To describe a uncommon complication of Voriconaole use that can be confused with relapse of disease.
Methods
A 6 year old boy with relapsed B cell ALL had a successful matched sibling donor transplant. Post transplant, patient was given presumptive therapy with liposomal amphotericin as his galactomannan screen was positive. Later his antifungal therapy was switched to voriconazole and he was discharged on the same.
Voriconazole levels were monitored and kept at a therapeutic level. On Day + 45 patient presented with severe leg pain and difficulty in walking. There were no neurological findings and a X Ray of the legs were normal. Suspecting a relapse, a bone marrow aspiration and biopsy was done which showed no evidence of disease recurrence with MRD being negative and 100% donor chimerism.
The pain increased in severity to an extent that the child stopped walking. A MRI scan was done which only showed periosteal thickening suggestive of mild periostitis over the tibia. Differential diagnosis of leukemic infiltration, osteomyelitis and drug induced periostitis was considered. As we had ruled out a relapse with a bone marrow examination and all inflammatory markers were negative, we deduced that drug induced periostitis was the most likely cause for the symptoms. Discontinuation of voriconazole led to complete resolution of pain within 48 hours.
Results
At one year post transplant, patient continued to be in remission and pain free.
Conclusion
Painful periostitis is a rare complication of long term voriconazole therapy which has only been recently reported in literature. Fluorosis and promotion of bone formation by osteoblast stimulation is the the proposed mechanism for voriconazole induced periostitis. Increased awareness of this rare condition can lead early correct diagnosis.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Side effects, Voriconazole
Abstract: PB2064
Type: Publication Only
Background
Voriconazole is commonly used antifungal agent used in paediatric oncology patients for prophylaxis and treatment of fungal infections. We report here on one of our post transplant patients who presented with acute bone pain over the tibia.
Aims
To describe a uncommon complication of Voriconaole use that can be confused with relapse of disease.
Methods
A 6 year old boy with relapsed B cell ALL had a successful matched sibling donor transplant. Post transplant, patient was given presumptive therapy with liposomal amphotericin as his galactomannan screen was positive. Later his antifungal therapy was switched to voriconazole and he was discharged on the same.
Voriconazole levels were monitored and kept at a therapeutic level. On Day + 45 patient presented with severe leg pain and difficulty in walking. There were no neurological findings and a X Ray of the legs were normal. Suspecting a relapse, a bone marrow aspiration and biopsy was done which showed no evidence of disease recurrence with MRD being negative and 100% donor chimerism.
The pain increased in severity to an extent that the child stopped walking. A MRI scan was done which only showed periosteal thickening suggestive of mild periostitis over the tibia. Differential diagnosis of leukemic infiltration, osteomyelitis and drug induced periostitis was considered. As we had ruled out a relapse with a bone marrow examination and all inflammatory markers were negative, we deduced that drug induced periostitis was the most likely cause for the symptoms. Discontinuation of voriconazole led to complete resolution of pain within 48 hours.
Results
At one year post transplant, patient continued to be in remission and pain free.
Conclusion
Painful periostitis is a rare complication of long term voriconazole therapy which has only been recently reported in literature. Fluorosis and promotion of bone formation by osteoblast stimulation is the the proposed mechanism for voriconazole induced periostitis. Increased awareness of this rare condition can lead early correct diagnosis.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Side effects, Voriconazole