title: Idiopathic osteonecrosis in an adult with familial protein S deficiency and hyperhomocysteinemia.
abstract: We describe a 36-year-old man with familial protein S deficiency and homozygosity to the methylene tetrahydrofolate reductase (MTHFR) thermolabile variant who had a stroke followed by an episode of idiopathic osteonecrosis that was successfully managed by surgical core decompression. The patient's symptomatic thrombophilia, as well as that of several of his first-degree relatives who also had thrombotic events, raises the possibility that the thrombophilia was a contributing factor to the development of his osteonecrosis.
authors.affiliation: Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: K
authors.initials: K
authors.lastname: Elishkewich
authors.forename: D
authors.initials: D
authors.lastname: Kaspi
authors.forename: I
authors.initials: I
authors.lastname: Shapira
authors.forename: D
authors.initials: D
authors.lastname: Meites
authors.forename: S
authors.initials: S
authors.lastname: Berliner
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005270:Femur Head; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010291:Paresis / Q000209:etiology; D010375:Pedigree; D018455:Protein S Deficiency / Q000150:complications / Q000235:genetics*; D011859:Radiography; D020521:Stroke / Q000150:complications; D013923:Thromboembolism / Q000517:prevention & control; D019851:Thrombophilia / Q000150:complications; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D005492:Folic Acid