□
PICTURES IN CLINICAL MEDICINE
□
Multiple Osteonecrosis with Systemic Lupus Erythematosus Gokhan Sargin and Taskin Senturk Key words: osteonecrosis, systemic lupus erythematosus (Intern Med 54: 2521-2522, 2015) (DOI: 10.2169/internalmedicine.54.4868)
Picture 1.
A twenty-year-old woman with a diagnosis of systemic lupus erythematosus (SLE) was referred to our clinic because of bilateral knee pain. She was treated with chloroquine, corticosteroid, cyclophosphamide, and mycophenolate mofetil due to her nephritis. She had a history of taking prednisone 1 mg/kg per day for the initial treatment of SLE and was taking 4 mg/day of methylprednisolone as a maintenance dose, when she was referred to our clinic. The duration of her glucocorticoid treatment was approximately 2 years. Her level of parathormone, thyroid-stimulating hormone, vitamin D, lipid, coagulation parameters, and antiphospholipid antibodies were all within normal ranges. The patient’s magnetic resonance imaging (MRI) and X-ray reports showed osteonecrosis of both femoral heads, femoral condyles, tibial plateaus, and scaphoids, the right lunatum, and the left distal radius (Picture 1, 2). Triamcinolone hexacetonide was administered into the right knee due to her arthritis. A bilateral total knee prosthesis was planned because of the patient’s continuing complaints. The term multifocal osteonecrosis is used to describe 3 or more osteonecrotic anatomical sites. The distal radius and ulna are rare sites for multifocal osteonecrosis. Stroh et al. reported 6 patients with atraumatic osteonecrosis of the disDepartment of Rheumatology, Adnan Menderes University Medical Faculty, Turkey Received for publication January 7, 2015; Accepted for publication March 1, 2015 Correspondence to Dr. Gokhan Sargin,
[email protected]
2521
Picture 2.
Intern Med 54: 2521-2522, 2015
DOI: 10.2169/internalmedicine.54.4868
tal radius and ulna (1). Smoking cigarettes, alcohol consumption, blood dyscrasias, SLE, and the use of cytotoxic drugs (especially corticosteroids) are risk factors for the development of osteonecrosis (1). Multiple osteonecrosis in patients with SLE is unusual and was reported in literature and a review (2). X-rays, MRIs, and scintigraphy are helpful methods for detecting lesions from osteonecrosis.
References 1. Stroh DA, LaPorte DM, Marker DA, Johnson AJ, Mont MA. Atraumatic osteonecrosis of the distal radius and ulna: case series and review. J Hand Surg Am 37: 134-141, 2012. 2. Fajardo-Hermosillo LD, López-López L, Nadal A, Vilá LM. Multifocal osteonecrosis in systemic lupus erythematosus: case report and review of the literature. BMJ Case Rep 2013: 2013.
The authors state that they have no Conflict of Interest (COI).
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
2522
