A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis (original) (raw)
Related papers
European Journal of Neurology, 2006
The most common cause avascular osteonecrosis (AVN) is corticosteroid medication. However, the impact of pulse steroid therapy on AVN development is not known properly. We intended to investigate the effect of this therapy on AVN development in multiple sclerosis (MS) patients. MS patients without AVN, chronic alcolism, thrombophilia, sickle cell anemia, inflamatory bowel disease, cytotoxic drug usage history participated in the study. All of the patients were ambulatory (EDSS < 4). Thirty-three MS patients who received pulse steroid therapy at least 10 g or at least 15 g during the course of the whole disease, were the treatment group and 27 MS patients who did not receive any steroid therapy were the control group. There was no statistical difference between groups for age, sex and disease duration. Bilateral femoral magnetic resonance imaging (MRI) was performed to the both groups. In the treatment group, five patients (15.5%) had AVN whilst no AVN was found in the control group. In conclusion, it is interesting to find AVN at such a high rate in the MS patients who received pulse steroid therapy without any AVN history or complaint. The neurologists have to be more careful about AVN which early diagnosis is important to prevent the complications.
International Journal of Surgery Case Reports, 2020
INTRODUCTION: Accelerated femoral head avascular necrosis after a single dose intra-articular steroid injection is a rare pathology. Few cases were reported in the literature. Most cases were managed with total hip arthroplasty. CASE PRESENTATION: In this study, we report two rare cases of destructive osteonecrosis of the femoral head. Both patients presented with hip osteoarthritis that failed nonoperative measures. A single intraarticular corticosteroid injection was administered for each patient. Both patients had femoral head destruction and significant resorption at 14 and 11 weeks, respectively. Septic arthritis was ruled out by blood tests and joint aspiration. Total hip arthroplasty (THA) was undertaken and histology reports confirmed the osteonecrosis. The postoperative follow-up was uneventful with satisfactory hip function. DISCUSSION AND CONCLUSION: Destructive osteonecrosis of the femoral head is a rare catastrophic potential complication of intra-articular corticosteroid injection. Hence, physicians must consider this complication when counseling patients before an intra-articular corticosteroid hip injection.
Corticosteroid pulse therapy-associated aseptic humeral and femoral head necrosis: a case report
Drugs & Therapy Perspectives, 2019
Corticosteroid pulse therapy is the administration of suprapharmacologic doses of corticosteroids in an intermittent manner to enhance their therapeutic effects and reduce their adverse effects. This report describes the complications of pulse therapy and long-term use of corticosteroids in a male patient aged 37 years who has had multiple sclerosis since 2003. The patient was diagnosed with aseptic necrosis of the humerus and femur heads after a course of corticosteroid pulse therapy in May 2015. This case is interesting not only because the patient developed aseptic necrosis of the femoral, as well as humeral, heads, but also because the patient received stem-cell therapy after an intensive course of corticosteroids as a recommended up-to-date therapy to treat this complication of pulse therapy.
FTR - Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi
Osteonecrosis is a common complication of corticosteroid therapy. In this study, we report the case of a patient with Posterior Inferior Cerebellar Artery (PICA)-Arteriovenous (AV) malformation who has been diagnosed with knee osteonecrosis involving bilateral proximal tibial and distal femur due to high-dose corticosteroid use. A 27-year-old male patient presented with a history of subarachnoidal hemorrhage due to PICA-AV. He had undergone Gamma knife radiosurgery and received short-term high-dose corticosteroid therapy (dxamethasone 16 mg/kg for 21 days). Two years later, he developed bilateral anterior knee pain of insidious onset. Magnetic resonance imaging performed on admission showed osteonecrosis of the bilateral proximal tibial and distal femur, more pronounced in the tibia. Osteonecrosis is a fairly common complication in patients with the history of corticosteroid use for the treatment of variety of systemic and rheumatic disorders. The condition can manifest itself anywh...
Acta orthopaedica et traumatologica turcica, 2007
We investigated the effect of corticosteroid treatment on the femoral head of healthy and serum disease-induced rats. Thirty Sprague-Dawley rats weighing 250-300 g were divided into three groups equal in number. In group A, serum disease was induced by two intraperitoneal injections of sterile human serum (10 ml/kg), interspersed with a two-week interval. The rats were then treated with methylprednisolone (40 mg/kg/day) for three consecutive days two weeks after the last injection. In group B, the animals received only methylprednisolone (40 mg/kg/day) for three days. In group C (controls), the same procedures were applied as those in group A, but with saline solution alone. All the rats were sacrificed two weeks after the last procedure. The left and right femora were sectioned axially and sagittally, respectively, to be examined under light microscopy with respect to vasculitis, hemorrhage in bone marrow, and changes in cell morphology. Histological examination showed decreased bo...
Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma
Nepal Journal of Epidemiology
The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whi...
Experience of Avascular Necrosis of Hip Joint due to Unjustified Use of Steroid: A Case Series Study
Bangladesh Journal of Pain, 2023
The use of steroids, whether in herbal or synthetic form, for purposes such as weight gain, appetite enhancement, and pain relief is a prevalent practice in Bangladesh. Lacking adherence to pharmacological guidelines, such as those outlined by the American College of Rheumatology (ACR) poses a significant health risk. Steroid-induced osteonecrosis is one in many adverse effects that consuming OTC steroid causes. AVN is characterized by the death of bone tissue due to the prolonged use or high-dose administration of corticosteroids. Commonly affected areas include the hip joints, knees, and shoulders. However, this seemingly innocuous trend has prompted concern, particularly at the Dhaka Specialized Pain Management and Research Centre, where a notable pattern has emerged. From July 2022 to June 2023, a total of 6 (six) reported cases highlighted a worrisome trend of individuals encountering health issues due to the misuse or prolonged use of over-the-counter (OTC) steroids. The majority of the reported cases were male, predominantly in their 2nd to 3rd decade of life. The common thread among these cases was the history of oral steroid ingestion, either in the form of herbal or synthetic compounds. The patients presented with complaints of pain in the hip and groin area, particularly during walking. Diagnostic imaging, including X-ray and MRI of the hip joints, consistently revealed a classical picture of Avascular Necrosis (AVN), underlining the potential association between steroid use and this debilitating condition. The cases reported at the Dhaka Specialized Pain Management and Research Centre serve as a stark reminder of the potential consequences, such as AVN, that can arise from the uninformed or unsupervised use of steroids.