"high serum total ALP and bone ALP levels and high plasma fluoride concentration 3,4,10"
"high serum total ALP and bone ALP levels and high plasma fluoride concentration 3,4,10"
"Voriconazole contains three fluorine atoms, and a 400 mg dose of voriconazole contains 65 mg of fluoride 5. In comparison, the fluoride content of the municipal tap water is 1 mg/L 6; thus, daily fluoride consumption from municipal tap water has been estimated at 2-4 mg per day 6."
"Absorbed excess fluoride is incorporated into the crystal structure of bony matrix called hydroxyapatite, forming fluorapatite 7. Unlike normal calcium hydroxyapatite, high fluorapatite deposit causes disorganised osteoblastic reaction, resulting in periosteal thickening or ossification, exostosis, osteosclerosis and decreased bone strength similar to skeletal fluorosis 2."
"Voriconazole-induced periostitis has been described as having a variable appearance of periosteal reaction including a fluffy, feathery, nodular or irregular morphology on imaging with an asymmetric distribution 8. Enthesopathy and capsulitis may also be present 10."
"The mainstay of imaging includes x-ray, CT and isotope bone scan. Advanced imaging modalities such as MRI and PET can be utilised if the diagnosis remains elusive, however, are not recommended as first-line 9."
"Common locations include the ribs, hands, shoulder girdle, pelvis, limbs, and teeth 1,10."