title: Bilateral Legg-Calve-Perthes Disease and Kienbock's Disease in a Child With Factor V Leiden Thrombophilia: A Case Report.
abstract: Background:The etiology of multifocal osteonecrosis is not definitively known; however, hypercoagulable state is a very plausible cause.Methods:We present an unusual case of a 12-year-old boy with a history of Legg-Calve-Perthes disease presenting with right wrist pain who was subsequently diagnosed with Kienbock's disease. The finding of multifocal osteonecrosis prompted testing for a hypercoagulable state that was positive for Factor V Leiden thrombophilia. A thorough literature review using Medline database was conducted to investigate associations between inherited hypercoagulable states and multifocal osteonecrosis.Results:Our literature review identified 2 similar cases of multifocal osteonecrosis associated with a hypercoagulable disorder in adult patients. There were no reports among the pediatric patient population. Meta-analysis has demonstrated a potential link between Legg-Calve-Perthes disease and Factor V Leiden thrombophilia.Conclusions:This study offers further evidence to support the theory that multifocal osteonecrosis may be linked to a hypercoagulable state. Patients presenting with multifocal osteonecrosis should undergo screening for hypercoagulable states. Further investigation is needed to ascertain the potential benefit of prophylactic anticoagulation in patients with a known hypercoagulable state and multifocal osteonecrosis.
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Baltzer
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Riester
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
mesh_terms: D020016:Activated Protein C Resistance / Q000150:complications* / Q000175:diagnosis; D002648:Child; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000150:complications*; D008297:Male; D010020:Osteonecrosis / Q000209:etiology*; D019851:Thrombophilia / Q000150:complications*
keywords: Factor V Leiden; Kienbock’s; Legg-Calve-Perthes disease; avascular necrosis; lunate