Fluoride Action Network


A 57-year-old man, who was receiving immunosuppressive therapy after liver transplantation, began receiving broad-spectrum antibiotics and antifungals (including amphotericin B liposomal) for a suspected fungal infection of the brain. Four days later, brain biopsy and subsequent culture led to identification of Scedosporium boydii/apiosperumum as the causative pathogen, and voriconazole [dosage and route of administration not stated] was added to his therapy; amphotericin B and other antibacterials were stopped, and voriconazole was continued as monotherapy. After approximately 2 months of antifungal therapy, he developed diffuse bone pain and weakness. His fluoride levels were elevated, but voriconazole concentrations were therapeutic (3.9 µg/mL). Treatment was changed to posaconazole and his symptoms resolved.

Author comment:“[V]oriconazole toxicity manifested as periostitis due to fluoride toxicity, despite voriconazole levels in the therapeutic range.”