ABSTRACT
Fungal infections are common in solid organ transplantation. An increasing number of transplant recipients receive antifungal therapy for prolonged duration owing to invasive fungal infections. Herein, we describe a diagnosis of periostitis as a complication of chronic use of voriconazole in a lung transplant recipient. The patient was diagnosed with probable pulmonary aspergillosis and was treated with oral voriconazole for a total of 9 months. Evidence of multifocal periostitis was observed in the axial and appendicular skeleton. Early recognition of this phenomenon is important to prevent unnecessary tests and procedures. Prompt discontinuation of voriconazole should result in improvement of symptoms.
Subject(s)
Antifungal Agents/adverse effects , Lung Diseases, Fungal/drug therapy , Lung Transplantation/adverse effects , Periostitis/microbiology , Pulmonary Aspergillosis/drug therapy , Pyrimidines/adverse effects , Triazoles/adverse effects , Aged , Antifungal Agents/therapeutic use , Chemoprevention , Female , Humans , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/microbiology , Male , Periostitis/complications , Periostitis/diagnosis , Periostitis/drug therapy , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/microbiology , Pyrimidines/therapeutic use , Triazoles/therapeutic use , VoriconazoleABSTRACT
The organization of the chitin-proteoglycan in Loligo vulgaris pen was examined ultrastructurally and related to the molecular order indicated by X-ray diffraction. There is a centrosymmetric striated repeat of 22 nm in the system which is based upon dark and light bands of unequal width. The banding is orientated perpendicular to the direction of the major molecular axis of the chitin fibres. The chitin molecules are laid down in sheets with a mutual, though irregular, twist to produce a laminated 'plywood' material.
