|IMAGE IN HEMATOLOGY
|Year : 2018 | Volume
| Issue : 4 | Page : 158
Bilateral femoral head osteonecrosis due to cyclosporine therapy in aplastic anemia
Mansoor C Abdulla, Ram Narayan
Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Kerala, India
|Date of Web Publication||4-Feb-2019|
Prof. Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College, Perinthalmanna - 679 338, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abdulla MC, Narayan R. Bilateral femoral head osteonecrosis due to cyclosporine therapy in aplastic anemia. J Appl Hematol 2018;9:158
A 48-year-old female was admitted with right-sided hip pain and low-grade fever for 1 month. She had diabetes mellitus and was diagnosed to have aplastic anemia 15 years back. She had a relapse and was on cyclosporine. She was not on steroids or other immunosuppressant agents. Examination showed severe pallor and tenderness over the right hip joint. Hemoglobin was 8.3 g/dl (normocytic and normochromic), total white blood cell count 1300/μl, platelet count 0.21 × 109/L, and erythrocyte sedimentation rate 72 mm in1 h. Peripheral smear showed pancytopenia. Magnetic resonance imaging of the hip showed bilateral osteonecrosis of femoral heads (Grade IV on the right and Grade II on the left side), an abscess of size 15 cm × 8 cm × 6.5 cm in the lower part of right iliopsoas muscle at the medial aspect of thigh [Figure 1]. She was treated conservatively for avascular necrosis of femoral heads. Incision and drainage of the iliopsoas abscess were done (pus culture grew Escherichia More Details coli) and was started on piperacillin-tazobactam with amikacin which was continued for 2 weeks followed by oral antibiotics.
|Figure 1: Magnetic resonance imaging of the hip showing bilateral osteonecrosis of femoral heads (Grade IV on the right and Grade II on the left side), an abscess of size 15 cm × 8 cm × 6.5 cm in the lower part of the right iliopsoas muscle at the medial aspect of the thigh|
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Most frequent causes of ischemia of the femoral head include trauma, corticosteroid therapy, radiation therapy, alcoholism, statins myeloproliferative disorders, human immunodeficiency virus, systemic lupus erythematosus, and sickle cell disease. Cyclosporine therapy was associated with osteonecrosis of femoral heads in renal transplant patients. Cyclosporine causing bilateral osteonecrosis of femoral heads is rare.
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