Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review

Abstract Background Voriconazole-induced periostitis is predominantly reported in adults, with pediatric cases being exceedingly rare. Case presentation This report describes an 8-year-old boy with voriconazole-induced periostitis presenting with finger pain and nodules, initially suspected to be bo...

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Main Authors: Hiroshi Urakawa, Kunihiro Ikuta, Tomohisa Sakai, Hiroshi Koike, Takeo Fujito, Yoshihiro Nishida, Shiro Imagama
Format: Article
Language:English
Published: BMC 2025-08-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-09059-z
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author Hiroshi Urakawa
Kunihiro Ikuta
Tomohisa Sakai
Hiroshi Koike
Takeo Fujito
Yoshihiro Nishida
Shiro Imagama
author_facet Hiroshi Urakawa
Kunihiro Ikuta
Tomohisa Sakai
Hiroshi Koike
Takeo Fujito
Yoshihiro Nishida
Shiro Imagama
author_sort Hiroshi Urakawa
collection DOAJ
description Abstract Background Voriconazole-induced periostitis is predominantly reported in adults, with pediatric cases being exceedingly rare. Case presentation This report describes an 8-year-old boy with voriconazole-induced periostitis presenting with finger pain and nodules, initially suspected to be bone tumors. The patient had been on voriconazole for two years and seven months to treat Aspergillus pneumonia and had been hospitalized for six months due to chronic graft-versus-host disease following hematopoietic stem cell transplantation and total body irradiation for severe congenital neutropenia. The patient presented with a five-month history of pain and a one-month history of a mass in the middle finger of his right hand. Radiographs revealed bone formation outside the cortical bone in the proximal phalanx of the right middle finger and the distal ulna. Differential diagnoses included benign bone-forming tumors, such as osteochondroma post-total body irradiation, and bizarre parosteal osteochondromatous proliferation. The diagnosis of voriconazole-induced periostitis was confirmed as new sites of periostitis became apparent during the disease course. Conclusions Voriconazole-induced periostitis should be considered, even in pediatric patients, when multiple nodular periosteal reactions are observed in immunosuppressed patients undergoing long-term voriconazole therapy.
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spelling doaj-art-81f2bc1606d14265bdf4d6a6a0fbf1f72025-08-20T03:04:07ZengBMCBMC Musculoskeletal Disorders1471-24742025-08-012611810.1186/s12891-025-09059-zVoriconazole-induced periostitis in a child with finger pain and nodules: case report and literature reviewHiroshi Urakawa0Kunihiro Ikuta1Tomohisa Sakai2Hiroshi Koike3Takeo Fujito4Yoshihiro Nishida5Shiro Imagama6Department of Advanced Medicine, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalDepartment of Orthopaedic Surgery, Nagoya University HospitalAbstract Background Voriconazole-induced periostitis is predominantly reported in adults, with pediatric cases being exceedingly rare. Case presentation This report describes an 8-year-old boy with voriconazole-induced periostitis presenting with finger pain and nodules, initially suspected to be bone tumors. The patient had been on voriconazole for two years and seven months to treat Aspergillus pneumonia and had been hospitalized for six months due to chronic graft-versus-host disease following hematopoietic stem cell transplantation and total body irradiation for severe congenital neutropenia. The patient presented with a five-month history of pain and a one-month history of a mass in the middle finger of his right hand. Radiographs revealed bone formation outside the cortical bone in the proximal phalanx of the right middle finger and the distal ulna. Differential diagnoses included benign bone-forming tumors, such as osteochondroma post-total body irradiation, and bizarre parosteal osteochondromatous proliferation. The diagnosis of voriconazole-induced periostitis was confirmed as new sites of periostitis became apparent during the disease course. Conclusions Voriconazole-induced periostitis should be considered, even in pediatric patients, when multiple nodular periosteal reactions are observed in immunosuppressed patients undergoing long-term voriconazole therapy.https://doi.org/10.1186/s12891-025-09059-zVoriconazole-induced periostitisDiagnosisCase reportLiterature review
spellingShingle Hiroshi Urakawa
Kunihiro Ikuta
Tomohisa Sakai
Hiroshi Koike
Takeo Fujito
Yoshihiro Nishida
Shiro Imagama
Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
BMC Musculoskeletal Disorders
Voriconazole-induced periostitis
Diagnosis
Case report
Literature review
title Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
title_full Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
title_fullStr Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
title_full_unstemmed Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
title_short Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review
title_sort voriconazole induced periostitis in a child with finger pain and nodules case report and literature review
topic Voriconazole-induced periostitis
Diagnosis
Case report
Literature review
url https://doi.org/10.1186/s12891-025-09059-z
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