Symptomatic, steroid-induced, multifocal diaphyseal osteonecrosis in a patient with multiple sclerosis.
There is a well-established link between the development of osteonecrosis and steroid administration. Diaphyseal osteonecrosis is rare and, when present, frequently asymptomatic and detected radiologically. We present a case of symptomatic, multifocal, diaphyseal osteonecrosis in a woman receiving pulsed corticosteroids for symptom control of multiple sclerosis (MS). She was investigated for knee pain, which could have been attributed to her primary disease, and magnetic resonance imaging (MRI) revealed bone infarcts within the femur, tibia and talus. She underwent successful intra-medullary reaming to the diaphyseal infarcts. This case highlights the importance of investigating musculoskeletal pain in patients with MS, receiving corticosteroids.
Sinclair
V
V
Royal Bolton Hospital, Bolton, UK. vicfsinclair@doctors.org.uk
Shepard
G
G
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D018483:Diaphyses / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005260:Female; D005269:Femur / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000188:drug therapy*; D019637:Orthopedic Procedures; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D020551:Pulse Therapy, Drug; D013628:Talus / Q000187:drug effects* / Q000473:pathology; D013977:Tibia / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone