Advertisement

Corticosteroid pulse therapy-associated aseptic humeral and femoral head necrosis: a case report

  • Dalia M. AminEmail author
Short Communication
  • 7 Downloads

Abstract

Corticosteroid pulse therapy is the administration of suprapharmacologic doses of corticosteroids in an intermittent manner to enhance their therapeutic effects and reduce their adverse effects. This report describes the complications of pulse therapy and long-term use of corticosteroids in a male patient aged 37 years who has had multiple sclerosis since 2003. The patient was diagnosed with aseptic necrosis of the humerus and femur heads after a course of corticosteroid pulse therapy in May 2015. This case is interesting not only because the patient developed aseptic necrosis of the femoral, as well as humeral, heads, but also because the patient received stem-cell therapy after an intensive course of corticosteroids as a recommended up-to-date therapy to treat this complication of pulse therapy.

Notes

Acknowledgements

The author gratefully acknowledges the support and help provided by the staff of the neurology and radiology departments of Zagazig University Hospital.

Compliance with ethical standards

Conflict of interest

Dalia M. Amin declares no conflict of interests in relation to this article.

Funding

No financial support was received for this case report.

Ethical considerations

This case report was approved by the local ethics committee of the Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt.

Informed consent

The patient gave informed written consent regarding the publication of the case report.

References

  1. 1.
    Sinha A, Bagga A. Pulse steroid therapy. Indian J Pediatr. 2008;75(10):1057–106.CrossRefGoogle Scholar
  2. 2.
    Laxler RM, Gazarian M. Pharmacology and Drug Therapy. In: Cassidy JT, Petty RE, Lindsley CB, Laxler RM, editors. Textbook of pediatric rheumatology, 5th ed. Philadelphia; WB Saunders Company; 2005. pp. 90–146.Google Scholar
  3. 3.
    Schimmer BP, Parker KL. Adrenocorticotropic hormones; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill Professional; 2006. p. 1587–612.Google Scholar
  4. 4.
    Carulli C, Nistri L, Bracco L, et al. A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis. Clin Cases Miner Bone Metab. 2015;12(3):257–9.Google Scholar
  5. 5.
    Kale N, Agaoglu J, Tanik O. Correlation of cumulative corticosteroid treatment with magnetic resonance imaging assessment of avascular femoral head necrosis in patients with multiple sclerosis. Neurol Int. 2010;2(2):e17.CrossRefGoogle Scholar
  6. 6.
    Ce P, Gedizlioglu M, Gelal F, et al. Avascular necrosis of the bones: an overlooked complication of pulse steroid treatment of multiple sclerosis. Eur J Neurol. 2006;13(8):857–61.CrossRefGoogle Scholar
  7. 7.
    Sahraian MA, Yadegari S, Azarpajouh R, et al. Avascular necrosis of the femoral head in multiple sclerosis: report of five patients. Neurol Sci. 2012;33(6):1443–6.CrossRefGoogle Scholar
  8. 8.
    Andriolo L, Merli G, Tobar C, et al. Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. Int Orthop. 2018;42(7):1689–704.CrossRefGoogle Scholar
  9. 9.
    Franceschi F, Franceschetti E, Paciotti M, et al. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3270–8.CrossRefGoogle Scholar
  10. 10.
    Vijapura A, Levine HB, Donato M, et al. Total hip arthroplasty in patients with avascular necrosis after hematopoietic stem cell transplantation. Orthopedics. 2018;41(2):e257–61.CrossRefGoogle Scholar
  11. 11.
    Canalis E. Mechanisms of glucocorticoid-induced osteoporosis. Curr Opin Rheumatol. 2003;15(4):454–7.CrossRefGoogle Scholar
  12. 12.
    Dovio A, Perazzolo L, Osella G, et al. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab. 2004;89:4923–8.CrossRefGoogle Scholar
  13. 13.
    Sanjeev M, Daksh G, Rahul G, et al. Prevalence of avascular necrosis of femoral head in patients with cirrhosis of liver. Int J Med. 2016;4(2):74–8.CrossRefGoogle Scholar
  14. 14.
    Shakoor A, Baig M. Osteonecrosis of the femoral head: etiology, investigations, and management. Cureus. 2018;10(8):e3171.Google Scholar
  15. 15.
    Gun I. Stem cell therapy in osteonecrosis of the femoral head. Hip Pelvis. 2018;30(3):135–7.CrossRefGoogle Scholar
  16. 16.
    Liu S, Liu D, Chen C, et al. MSC transplantation improves osteopenia via epigenetic regulation of notch signaling in lupus. Cell Metab. 2015;22:606–18.CrossRefGoogle Scholar
  17. 17.
    Cho SW, Sun HJ, Yang JY, et al. Transplantation of mesenchymal stem cells overexpressing RANK-Fc or CXCR4 prevents bone loss in ovariectomized mice. Mol Ther. 2009;17:1979–87.CrossRefGoogle Scholar
  18. 18.
    Lien CY, Chih-Yuan Ho K, Lee OK, et al. Restoration of bone mass and strength in glucocorticoid-treated mice by systemic transplantation of CXCR4 and cbfa-1 co-expressing mesenchymal stem cells. J Bone Miner Res. 2009;24:837–48.CrossRefGoogle Scholar
  19. 19.
    Zhang XS, Linkhart TA, Chen ST, et al. Local ex vivo gene therapy with bone marrow stromal cells expressing human BMP4 promotes endosteal bone formation in mice. J Gene Med. 2004;6:4–15.CrossRefGoogle Scholar
  20. 20.
    Piuzzi NS, Chahla J, Schrock JB, et al. Evidence for the use of cell-based therapy for the treatment of osteonecrosis of the femoral head: a systematic review of the literature. J Arthroplasty. 2017;32:1698–708.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Forensic Medicine and Clinical Toxicology Department, Faculty of MedicineZagazig UniversityZagazigEgypt

Personalised recommendations