Multifocal osteonecrosis affecting all four limbs in systemic lupus erythematosus: A case report

Osteonecrosis is a condition that frequently affects patients with systemic lupus erythematosus (SLE). However, reports on severe multifocal osteonecrosis involving more than three anatomical sites in patients with SLE are scarce. The present study describes a case of SLE with multifocal osteonecrosis involving all four limbs. A 22-year-old woman was diagnosed with SLE in 2010 and the disease was controlled by treatment with methylprednisolone and hydroxychloroquine. Approximately 1 year following the diagnosis of SLE, the patient developed pain in the elbows and hips. Magnetic resonance imaging revealed evidence of multifocal osteonecrosis in the bilateral distal segments of the humerus and femoral head, the distal segment of the right femur and the proximal segment of the right tibia. The patient was treated with right total hip arthroplasty and core decompression of the right femur and tibia, followed by continuation of the earlier medical treatment for SLE. The present case highlights the importance of conducting a careful investigation of patients with SLE who present with multiple joint involvement, and the choice of the appropriate treatment according to the presentation.