Abstract
Glucocorticoids (GC), often used in the treatment
of diseases caused by autoimmune mechanisms, are the most common nontraumatic
causative factor of femoral head avascular necrosis (FHAN). FHAN is, in turn,
the most common cause leading to orthopedic surgery in patients using GCs. As
GCs suppress the immune system, patients experience increased susceptibility to
infections, including FHAN, which has a similar clinical manifestation with
septic arthritis. In rare cases, septic arthritis may be caused by salmonella
in patients using GCs. Core decompression is the gold standard in the treatment
of early stage FHAN.
We report a 28-year-old male patient with multiple
sclerosis (MS) presenting with the complaints of hip pain. The patient had been
treated with two megadoses of steroids. FHAN was considered due to X-ray and
MRI findings. The patient underwent core decompression (CD) and salmonella
bacteria growth was found in the hip puncture culture. Avascular necrosis
associated with septic arthritis was determined. The patient was re-operated
and irrigation and debridement for synovial tissues were performed two days following
the first operation. While the association of septic arthritis with causative Salmonella
and FHAN is rare except in sickle cell patients, septic arthritis must be considered
and ruled out in patients who have previously undergone C
Keywords
References
- 1. Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am. 1995;77:674-80.
Abstract
Glikokortikoidler (GK)
otomimmün hastalıkların tedavilerinde sıklıkla kullanılmaktadırlar ve femur
başı avasküler nekrozunun (FBAN) bilinen en sık travmatik olmayan sebebidirler.
GK kullanan hastalardaki en sık ortopedik cerrahi nedeni ise FBAN’dur. GK’ler
immün sistemi baskılayarak enfeksiyona yatkınlığı artırır. FBAN septik artrit
ile benzer klinik tabloya sahiptir. GK kullanan hastalarda Salmonella nadir bir
septik artrit sebebidir. Erken evre FBAN tedavisinde kordekompresyon altın
standart tedavi yöntemidir. Hastamız 28 yaşında erkek ve kliniğimize kalça ağrısı
şikayeti ile başvurdu. Öyküsünden Multipl Skleroz tanısı (MS) sebebiyle iki
kere megadoz steroid tedavisi gördüğünü öğrendik. Röntgen ve MRI bulguları
FBAN’u destekler nitelikteydi. Hastaya kordekompresyon operasyonu uyguladık ve
eklem sıvısından örnek aldık.
Operasyondan sonra alının örnekte Salmonella bakterisi üremesi üzerine
FBAN’nun septik artrit ile birlikte olduğunu anladık. Hastayı ilk
operasyonunundan 2 gün sonra tekrar opere ederek sinoviyal dokulara yönelik
debridman ve yıkama işlemi uyguladık. Salmonella septik artriti ile FBAN
birlikteliği orak hücreli anemisi olan hastalarda bildirilmesine rağmen
nadirdir. Erken evre FBAN sebebiyle kordekompresyon uygulanan ve beklenen
klinik iyileşme görülmeyen hastalarda septik artrit ekarte edilmelidir
Keywords
References
- 1. Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am. 1995;77:674-80.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 31, 2016 |
| Acceptance Date | April 28, 2016 |
| Published in Issue | Year 2016 |
