Abstract
Avascular necrosis (AVN) is a serious condition that develops as a result of inadequate blood supply to bone tissue. This condition is usually associated with trauma, long-term steroid use, or systemic diseases. Spondylodiscitis is a serious infection affecting the spinal discs and vertebral bodies and is usually of bacterial origin. The association of spondylodiscitis and avascular necrosis is rare. In this case report, bilateral femoral head avascular necrosis and spondylodiscitis coexistence in a 53-year-old female patient diagnosed with ulcerative colitis is discussed. This case aims to emphasize the risk of developing AVN and spondylodiscitis in patients with chronic inflammatory disease who receive long-term corticosteroid treatment.
Keywords: Avascular necrosis, spondylodiscitis, inflammation, corticosteroid, osteoimmunology, spondyloarthropathy
References
Lai SW, Lin CL, Liao KF. Evaluating the association between avascular necrosis of femoral head and oral corticosteroids use in Taiwan. Medicine. 2020;99:18585.
Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65:11-24.
Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002;32:94-124.
Goodman SB, Maruyama M. Inflammation, bone healing and osteonecrosis: From bedside to bench. J Inflammation Res. 2020;13:913-23.
Zheng J, Yao Z, Xue L, Wang D, Tan Z. The role of immune cells in modulating chronic inflammation and osteonecrosis. Front Immunol. 2022;13:1064245.
Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010;9:721-43.
Zizic TM, Marcoux C, Hungerford DS, Dansereau JV, Stevens MB. Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med. 1985;79:596-604.
Shibatani M, Fujioka M, Arai Y, Takahashi K, Ueshima K, Okamoto M, et al. Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head. Acta Orthop. 2008;79:631-6.
Koo KH, Kim R, Kim YS, Ahn IO, Cho SH, Songet HR, et al. Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. Clin Rheumatol. 2002;21:299-303.
Di Martino A, Papapietro N, Lanotte A, Russo F, Vadalà G, Denaro V. Spondylodiscitis: standards of current treatment. Curr Med Res Opin. 2012;28:689-99.
Loi F, Cordova LA, Pajarinen J, Lin TH, Yao Z, Goodman SB. Inflammation, fracture and bone repair. Bone. 2016;86:119-30.
Sobottke R, Seifert H, Fätkenheuer G, Schmidt M, Gossmann A, Eysel P. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int. 2008;105:181-7.
Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R. Spondylodiscitis: diagnosis and treatment options. Dtsch Arztebl Int. 2017;114:875-82.
Yu R, Zhang J, Zhuo Y, Hong X, Ye J, Tang S, et al. Arg2, Map4k5 and Tsta3 as diagnostic markers of steroid-induced osteonecrosis of the femoral head and their correlation with immune infiltration. Front Genet. 2021;12:691465.
Andersson O. Rontgenbilden vid spondylarthritis ankylopoetica. Nord Med Tidskr. 1937;14:2000-5.
Rasker JJ, Prevo RL, Lanting PJ. Spondylodiscitis in ankylosing spondylitis, inflammation or trauma? A description of six cases. Scand J Rheumatol. 1996;25:52-7.
