Liu Bo, Zhang Yao, Zhang Qiang
Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, National Center for Infectious Diseases, Beijing, People's Republic of China.
Infect Drug Resist. 2024 Aug 13;17:3519-3525. doi: 10.2147/IDR.S472009. eCollection 2024.
Osteonecrosis is a common complication, particularly in HIV-infected patients undergoing long-term glucocorticoid therapy. This case report aims to highlight the unique "map-like" magnetic resonance imaging (MRI) changes observed in an HIV-positive patient with multiple osteonecrosis due to glucocorticoid overdose, emphasizing the importance of recognizing and managing this complication in this high-risk population.
A 29-year-old HIV-positive male patient developed extensive multi-joint osteonecrosis involving 7 joint sites (right shoulder, bilateral hips, bilateral knees, and bilateral ankles) after 6 months of high-dose glucocorticoid treatment for an opportunistic pneumonia associated with his HIV status. The patient required prolonged glucocorticoid therapy to manage the severe lung infection. MRI revealed characteristic "map-like" changes, with the osteonecrotic areas distributed in a linear, clustered, or map-like pattern. To alleviate his condition and improve joint function, the patient underwent a customized treatment plan, including total hip replacement for the left hip, core decompression surgery for the right hip. Following surgical intervention, the patient experienced reduced joint pain and improved joint mobility.
This case underscores the potential risk of extensive multi-joint osteonecrosis in HIV-positive patients receiving long-term high-dose glucocorticoids, with the "map-like" MRI changes being a distinctive imaging feature. It emphasizes the importance of close monitoring and timely implementation of effective interventions in this high-risk population. Notably, core decompression surgery can improve local blood circulation, slow disease progression, and serve as an effective minimally invasive treatment option for early-stage osteonecrotic lesions.
骨坏死是一种常见的并发症，尤其在接受长期糖皮质激素治疗的HIV感染患者中。本病例报告旨在突出一名因糖皮质激素过量导致多处骨坏死的HIV阳性患者所观察到的独特“地图样”磁共振成像（MRI）变化，强调在这一高危人群中识别和管理这种并发症的重要性。
一名29岁的HIV阳性男性患者，在因与HIV状态相关的机会性肺炎接受6个月的高剂量糖皮质激素治疗后，出现了累及7个关节部位（右肩、双侧髋关节、双侧膝关节和双侧踝关节）的广泛多关节骨坏死。该患者需要长期的糖皮质激素治疗来控制严重的肺部感染。MRI显示出特征性的“地图样”变化，骨坏死区域呈线性、簇状或地图样分布。为了缓解病情并改善关节功能，患者接受了定制的治疗方案，包括对左髋关节进行全髋关节置换，对右髋关节进行髓芯减压手术。手术干预后，患者的关节疼痛减轻，关节活动度改善。
本病例强调了接受长期高剂量糖皮质激素治疗的HIV阳性患者发生广泛多关节骨坏死的潜在风险，“地图样”MRI变化是一种独特的影像学特征。它强调了在这一高危人群中密切监测和及时实施有效干预的重要性。值得注意的是，髓芯减压手术可以改善局部血液循环，减缓疾病进展，并作为早期骨坏死病变的一种有效的微创治疗选择。
