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IMAGE IN HEMATOLOGY
Year : 2018  |  Volume : 9  |  Issue : 4  |  Page : 158

Bilateral femoral head osteonecrosis due to cyclosporine therapy in aplastic anemia


Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Kerala, India

Date of Web Publication4-Feb-2019

Correspondence Address:
Prof. Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College, Perinthalmanna - 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_50_17

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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

How to cite this URL:
Abdulla MC, Narayan R. Bilateral femoral head osteonecrosis due to cyclosporine therapy in aplastic anemia. J Appl Hematol [serial online] 2018 [cited 2019 Jul 22];9:158. Available from: http://www.jahjournal.org/text.asp?2018/9/4/158/251490

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.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


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