Case Reports Epublish 1 citation
PubMed: 36147607
Rheumatological picture of a patient having multifocal osteonecrosis associated with sickle cell anemia: a case study.
Am J Blood Res 12(4):156-162
Authors: Albader Hamza Hussein, Abdulhalem A Jan, Lujain K Alharbi, Khaled A Khalil, Abdelrahman I Abdelrahman, Salah Mohamed El Sayed
Affiliations
- Rheumatology Department, King Fahd Hospital, Al-Madinah Governorate of Health Al-Madinah, Saudi Arabia.
- Cellular and Molecular Biology Division, Medical Laboratory, King Fahd Hospital, Al-Madinah Governorate of Health Al-Madinah, Saudi Arabia.
- Department of Diagnostic Radiology, Jaber Al Ahmad Hospital Kuwait.
- Department of Diagnostic Radiology, Zagazig Faculty of Medicine, Zagazig University Egypt.
- Department of Clinical Biochemistry and Molecular Medicine, Taibah Faculty of Medicine, Taibah University Al-Madinah Al-Munawwarah, Saudi Arabia.
- Department of Medical Biochemistry, Sohag Faculty of Medicine, Sohag University Sohag, Egypt.
Abstract
Avascular necrosis (AVN) is a critical health condition associated with local death of the bone tissue resulting in multifocal osteonecrosis (MFON). After a prior patient's consent, we present a case of sickle cell anemia associated with severe MFON that affected both long bones and short bones. She had a positive history of DVT. Initially, she presented with generalized severe bone pain with fever for seven days that got worse on the day of admission, a picture suggestive of sickle cell anemia-induced vaso-occlusive crisis. She was treated with adequate hydration, morphine, enoxaparin (a low molecular weight heparin), paracetamol and ceftriaxone. She got improved on treatment. On 5 day after admission, she developed sudden severe local tenderness at the distal tibia above the medial malleoli in both legs and she was unable to put a weight on her feet and could not stand up or walk. Plain X-ray films were not diagnostic. Complete liver function tests and kidney function tests were normal. The patient had leukocytosis, high serum urate and high serum LDH (may reflect cellular damage in bone cells). MRI scans revealed an evidence of bilateral multiple avascular necrosis in both femoral heads, left shoulder, left knee, and pelvic bones were evident. The patient's condition was evaluated and the diagnosis of MFON associated with sickle cell crisis was established. This patient responded well to same treatments and her condition got improved. In conclusion, MFON should be considered after vaso-occlusive crisis of sickle cell anemia. Plain X-ray is non-conclusive in diagnosing bony lesions induced by AVN while MRI is diagnostic.
MeSH
Cells, Uric Acid, Enoxaparin, Serum, Anemia, Sickle Cell, Anemia, Necrosis, Therapeutics, Leukocytosis, Osteonecrosis