PC-05. Alcohol-associated avascular bone necrosis. Case report
Vsevolod G. Potapenko1, Evgenij P. Burlachenko4, Alexej I. Berdes5, Inna M. Corablina3, Alexander I. Kazancev2, Sergey L. Vorobyev3
1 Municipal Clinical Hospital No.31, St. Petersburg, Russia
2 Municipal Polyclinic No.19, St. Petersburg, Russia
3 Natiоnal Center for Clinical Morphological Diagnostics, St. Petersburg, Russia
4 Medical center “Kardioklinika”, St. Petersburg, Russia
5 Orthopedic Clinic, Institute of Phthysiopulmonology, St. Petersburg, Russia
Dr. Vsevolod G. Potapenko, phone: +7 (905) 284-51-38, e-mail: firstname.lastname@example.org
Avascular necrosis of the bones (AN) can be induced by different factors. There are very few reports of alcohol-associated AN as a factor. We present a case report of the patient with alcohol-associated AN.
Male, 37 y.o., started regular strong drinks consumption. After two years pain in the right hip joint appeared. NSAIDs were taken daily. MRI scan revealed destruction of the right femoral bone head. After 7 months femoral spacer was implanted. The microscopic examination of the bone showed uneven osteolysis, weak osteoclastic reaction without osteoblastic proliferation, profound interbeam spaces fibrosis, and substitution of the bone marrow with fibrovascular tissue with mild local plasmocytic reaction. Plasma cells expressed CD138, but light chains restriction was not found. Alcohol consumption persisted and pain spread to knees, wrists and elbows. The pain was associated with movement. There was no local edema and swelling in affected joints. The patient was referred to a hematologist to exclude myeloma. CT scan revealed loosening and fragmentation of the right shoulder bone head and left femoral bone head with pseudoartrosis (Fig. 1, 2). The diagnosis of advanced avascular necrosis stage was suspected. Alcoholisation stopped and in a next 11 month joint pain resolved. Then alcohol consuption resumed but mainly with mild drinks (20 alcohol units per week). The pain didn`t recur during the next 30 months.
Figure 1. Pseudoarthrosis of the left hip joint. Head of the left femoral bone is fragmented
Figure 2. Avascular necrosis of right humeral bone head
Alcohol abuse can be the cause of bone avascular necrosis.
Avascular necrosis, alcohol consumption, multiple myeloma.