engleski

Osteomyelitis and multiple avascular necrosis of bone (AVN) in a patient with systemic lupus erythematosus (SLE).

BACKGROUND AND AIMS: AVN is a rare musculoskeletal manifestation in patients with SLE. The poorly vascularized bone is a well recognized predisposing factor to osteomyelitis, but coincidental development of AVN and bone infection in SLE has rarely been described. METHODS: We present a 17 year-old girl who was admitted to Department in June 2006 with a 3-week history of polyarthralgia, fever and headache. RESULTS: Diagnosis of SLE was made according to ACR criteria and treatment with methylprednisolone was started. She didn’ t respond well, and hydroxycloroquine and azathioprine were introduced. Three months later, she was readmitted because of right knee pain and myalgia with increased acute inflammatory parameters. SLE laboratory features were negative. Four days later she developed fever with painful and swollen right low extremity. She was diagnosed by MRI as having bilateral tibial AVN and distal femoral and proximal tibial osteomyelitis. Biopsy and drainage of right distal femur and knee were performed, and the culture revealed the presence of Staphylococcus aureus. Owing to severe sideffects to clindamycin and ciprofloxacin, therapy was modified to rifampicin and cloxacillin, which she is still receiving. Methylprednisolone was tapered and azathioprine was stopped. At present, SLE is in complete remission and there are no clinical signs of infection. CONCLUSIONS: We described a severe complication in SLE patients, mainly caused by high dose of corticosteroids. In our Department, in a last ten yrs, 54 pts were diagnosed as SLE and treated with high doses of corticosteroids, but none developed AVN. Therefore we believe, that the possible influence of other factors such as gene defect(s) or some other environmental factors in addition to the proposed defects in T-cell function in SLE patients might contribute to the appearance of multifocal AVN.

avascular necrosis of bone; SLE; child; therapy

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