Voriconazole-Induced Periostitis: A Radiographic Progression

We present a case of incidentally discovered Voriconazole-induced periostitis in a patient with chronic lymphocytic leukemia. Voriconazole was initiated approximately two years prior to the periostitis discovery on a chest CT for acute on chronic respiratory failure. Because of the asymptomatic nature of the periostitis and its slow development, it was not reported on imaging for over two years. The periostitis was followed retrospectively over a two-year span from the patient’s surveillance imaging. Although there are several cases of periostitis from chronic Voriconazole use in the literature, this case is made unique in its asymptomatic presentation, allowing for a visual display of periostitis progression over two years. This case highlights the fact that Voriconazole-induced periostitis can be asymptomatic and should, therefore, be readily recognized and include a comprehensive differential.