Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Pseudo-Hypertrophic Osteoarthropathy in Lung Transplant Recipients on Long Term Voriconazole Therapy.

Saggar1,  Rajan, Wang3,  Tisha, Saggar3,  Rajeev, Altman2,  Roy D.

UCLA, Los Angeles, CA
UCLA, Agua Dulce, CA


Report a series of patients with a newly described syndrome


Seven cases of lung transplant recipients on long term voriconizole developed a musculoskeletal syndrome.


Lung transplantation was undertaken for end-stage emphysema, sarcoidosis, and idiopathic pulmonary fibrosis. Oral voriconazole was initiated as prophylaxis after isolation of Aspergillus spp. after surveillance bronchoscopy. After 6 to 26 months of therapy with voriconizole (200mg bid), this subset of patients presented with non-specific, diffuse bony pain involving arms, shoulders, thighs, knees and shins. Serum alkaline phosphatase was elevated to 1.1 to 7 times the upper limit of normal. Bone scanning with Tc-99m revealed localization of the nuclide to long bones in a spotty distribution atypical for hypertrophic osteoarthropathy. None of the cases had associated clubbing. 2 cases demonstrated periostitis on plain radiograph. Symptoms remised within 2–4 weeks of discontinuation of voriconazole. Repeat bone scan within 6 weeks of voriconazole discontinuation demonstrated significantly reduced accumulation of nuclide.


A syndrome of diffuse extremity pain with periostitis can be seen in lung transplant patients on long term voriconizole. It is suspected that this syndrome may also be seen with azole therapy in long term use for other transplant recipients.

To cite this abstract, please use the following information:
Saggar, Rajan, Wang, Tisha, Saggar, Rajeev, Altman, Roy D.; Pseudo-Hypertrophic Osteoarthropathy in Lung Transplant Recipients on Long Term Voriconazole Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :907
DOI: 10.1002/art.28675

Abstract Supplement

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