Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options.

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Abstract

[Indexed for MEDLINE] 9. Radiol Case Rep. 2024 Dec 19;20(3):1431-1434. doi: 10.1016/j.radcr.2024.11.079. eCollection 2025 Mar. Voriconazole-induced periostitis in the hand. Singh G(1), Motamedi D(2), Sweetwood K(2). Author information: (1)School of Medicine, University of California-San Francisco, 533 Parnassus Ave, San Francisco, CA, USA. (2)Department of Radiology, University of California-San Francisco, 513 Parnassus Ave, Room S257, Box 0628, San Francisco, CA 94143, USA. 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. © 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington. DOI: 10.1016/j.radcr.2024.11.079 PMCID: PMC11728661