title: Bilateral femoral head osteonecrosis after septic shock and multiorgan failure.
abstract: A case of bilateral femoral head osteonecrosis after septic shock is presented. We suggest that the osteonecrosis was caused by ischemic insults to the proximal femora. The association between septic shock and osteonecrosis has not been previously reported.
  
  
  BACKGROUND
  Osteonecrosis is an uncommon disorder characterized by the in situ death of bone. A diverse range of conditions has been associated with osteonecrosis. We present a case of bilateral femoral head osteonecrosis that occurred after an episode of septic shock.
  
  
  METHODS
  A 66-year-old woman presented with a left-sided renal stone and a urinary tract infection. Her condition rapidly progressed to a life-threatening illness with septic shock complicated by multiorgan failure, which necessitated prolonged intensive care and inotropic support. She made a full recovery but 3 months later developed bilateral osteonecrosis of the femoral heads requiring bilateral total hip joint replacement.
  
  
  CONCLUSIONS
  We propose that the osteonecrosis was caused by ischemic insults to the femoral heads as a result of the widespread systemic ischemia that occurred during her initial illness. To our knowledge, septic shock has not been previously described as a cause of osteonecrosis. Clinicians should be aware of this association, particularly in patients presenting with bone pain after episodes of sepsis.
authors.affiliation: Department of Endocrinology, Auckland Hospital, Auckland, New Zealand. mbolland@adhb.govt.nz
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bolland
authors.forename: Gill
authors.initials: G
authors.lastname: Hood
authors.forename: Sonja T
authors.initials: ST
authors.lastname: Bastin
authors.forename: Alan R
authors.initials: AR
authors.lastname: King
authors.forename: Andrew
authors.initials: A
authors.lastname: Grey
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000368:Aged; D016470:Bacteremia / Q000652:urine; D005260:Female; D005271:Femur Head Necrosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D009102:Multiple Organ Failure / Q000150:complications*; D012772:Shock, Septic / Q000150:complications*
chemical_list: D000305:Adrenal Cortex Hormones