Rare localization of avascular necrosis during treatment of COVID-19 with glucocorticosteroids

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Abstract

The development of bony avascular necrosis induced by glucocorticoid treatment of COVID-19 is a common adverse effect, with femoral head being the most commonly affected. Timely detection of avascular necrosis is important in the prevention of osteoarthrosis and other complications.

We present a clinical case of a 54-year-old patient hospitalized for novel coronavirus infection with complaints of severe pain in both knees 2 weeks after the disease onset. Magnetic resonance imaging revealed pronounced changes in both knees, corresponding to avascular necrosis. The results of conservative therapy, including non-steroidal anti-inflammatory drugs and bisphosphonate bone resorption inhibitors, produced a pronounced positive result. At follow-up examination 3 months later, there was no pain, but the knee joints still had slight restrictions of movement. Magnetic resonance imaging showed a significant decrease in the previously detected changes.

The side effects of glucocorticoids (impaired glucose tolerance, increased blood pressure, tachycardia, gastrointestinal erosive ulcers, sleep disorders, etc.) are widely known, but knee osteonecrosis caused by steroid intake rarely comes to the attention of clinicians. This clinical case emphasizes the complex nature of osteonecrosis pathogenesis and demonstrates a wide range of complications in corticosteroid therapy.

About the authors

Anna P. Gonchar

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: a.gonchar@npcmr.ru
ORCID iD: 0000-0001-5161-6540
SPIN-code: 3513-9531
Russian Federation, Moscow

Ivan A. Blokhin

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: i.blokhin@npcmr.ru
ORCID iD: 0000-0002-2681-9378
SPIN-code: 3306-1387
Russian Federation, Moscow

Yuliya F. Shumskaya

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies; The First Sechenov Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: yu.shumskaia@npcmr.ru
ORCID iD: 0000-0002-8521-4045
SPIN-code: 3164-5518
Russian Federation, Moscow; Moscow

References

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2. Fig. 1. Primary MRI of the left knee joint: PDWI with fat suppression in the coronal (а) and sagittal (b) plane and T1WI in the sagittal plane (с). The arrows indicate areas of bone marrow edema in the form of a heterogeneous, irregularly shaped (“geographic”) MRI signal of femoral and tibial condyles.

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3. Fig. 2. Primary MRI of the right knee joint: PDWI with fat suppression in the coronal (а) and sagittal (b) plane and T1WI in the sagittal plane (с). Thick arrows indicate areas of bone marrow edema in the form of a heterogeneous, irregularly shaped (“geographic”) MRI signal of femoral condyles and patella; thin arrows indicate the “double line” sign in the form of internal hyperintense (granulation tissue) and external hypointense (osteosclerosis) lines on PDWI.

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4. Fig. 3. Follow-up MRI of the left knee joint: PDWI with fat suppression in the coronal (а) and sagittal (b) plane and T1WI in the sagittal plane (с). Thick arrows indicate areas of bone marrow edema in the form of a heterogeneous, irregularly shaped (“geographic”) MRI signal of femoral condyles and patella; the thin arrow indicates the “double line” sign in the form of internal hyperintense (granulation tissue) and external hypointense (osteosclerosis) lines on PDWI.

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5. Fig. 4. Follow-up MRI of the right knee joint: PDWI with fat suppression in the coronal (а) and sagittal (b) plane and T1WI in the sagittal plane (с). Thick arrows indicate areas of bone marrow edema in the form of a heterogeneous, irregularly shaped (“geographic”) MRI signal of femoral condyles and patella; thin arrows indicate the “double line” sign in the form of internal hyperintense (granulation tissue) and external hypointense (osteosclerosis) lines on PDWI.

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