Voriconazole-induced periostitis in the hand

Voriconazole, a triazole antifungal, has proven effective against invasive fungal infections, and is often selected due to its enhanced antifungal spectrum coverage. Despite its general tolerability, voriconazole usage is associated with drug-induced periostitis, which presents with diffuse bone pain. This case report details a 65-year-old male on chronic immunosuppressive and antimicrobial therapy following heart transplant who developed hand pain. Identification of periostitis on hand radiographs and an acute elevation of alkaline phosphatase on subsequent blood analysis prompted discontinuation of voriconazole, resulting in a symptomatic and laboratory improvement. This case underscores the importance of leveraging a thorough understanding of imaging features, clinical manifestations, and laboratory data to aid in the diagnosis of voriconazole-induced periostitis.