Rapid onset avascular necrosis secondary to misuse of appetite stimulant

BACKGROUND: HIV patients often fear disclosure of their status and consequently are fearful that their appearance may lead people to believe they have HIV. Excessive attention to weight is one result. CASE PRESENTATION: We present a case of bilateral avascular necrosis (AVN) of the femoral heads secondary to megestrol misuse. Multiple providers with non-communicating electronic medical records contributed to this event, especially in our patient who was a guarded historian. Because of altered body image and fear of HIV disclosure, our patient who was already prescribed an antiretroviral associated with decreased bone density, sought an appetite stimulant and used far more than the prescribed dose leading to rapid onset AVN. CONCLUSIONS: Use of appetite stimulants in HIV should be carefully monitored and utilized only when weight loss is excessive and documented, and steroid based appetite stimulants should be avoided.