technetium-tc-99m-medronate and Opportunistic-Infections

While drug-related periostitis has been known of for many years, the specific association of diffuse periostitis with voriconazole (most frequently in transplant patients) has only been recently explicitly addressed in the literature. Recognition of the radiologic and clinical manifestations of voriconazole-related periostitis is important for helping to narrow an otherwise broad differential diagnosis. We present two cases that illustrate different radiologic presentations of this painful cause of diffuse periostitis. Case 1 features a 60 year-old woman with a history of orthotopic heart transplant who was hospitalized for "full body pain" with progressively worsening bone tenderness involving the humeri, knees, femurs, hips, and hands. Case 2 describes a 48 year-old man with a history of acute lymphoblastic leukemia status post stem cell transplant who presented with diffuse arthralgias involving bilateral ankles, knees, wrists, and elbows.

Topics: Antifungal Agents; Female; Heart Transplantation; Humans; Male; Middle Aged; Opportunistic Infections; Periostitis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pulmonary Aspergillosis; Pyrimidines; Radionuclide Imaging; Radiopharmaceuticals; Stem Cell Transplantation; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Triazoles; Voriconazole

Diffuse pulmonary uptake of both technetium-99m- labeled methylene diphosphonate (99(m)Tc-MDP) and gallium (67Ga) citrate was noted in a patient with chronic renal failure and indicated the presence of pulmonary calcinosis. The uptake of 67Ga could be misinterpreted to represent abnormal uptake due to an opportunistic infection.

Topics: Adolescent; Calcinosis; Female; Gallium Radioisotopes; Humans; Kidney Failure, Chronic; Lung; Lung Diseases; Opportunistic Infections; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Staphylococcal Infections; Technetium Tc 99m Medronate