Presentation
Post COVID-19 status complaining of left hip pain for 4 months
Patient Data
Sunchondral T1-hypointense crescentic line extending between 2-10 o’clock in the anterosuperior quadrant of left femoral head. Double line sign with accompanying marrow edema in the left femoral head and neck, extending almost to greater trochanter. Left femoral head volume and shape is preserved, as is congruity of left hip joint surface. No significant joint effusion on left. Increased T2 signal in left gluteus minimus muscle near its trochanteric insertion.
Case Discussion
The coronavirus 2 (SARS-CoV-2) (COVID-19) pandemic has stimulated an unprecedented response by the global scientific community to better understand the disease. Systemic inflammation may play a role in the physiology of bone and joint tissue in COVID-19 patients. Cytokines that are induced by COVID-19 include CXCL10, IL-17, and TNF-alpha and are responsible for reducing the proliferation and differentiation of osteoblasts. Corticosteroids administered to most patients treated for COVID-19 in hospital also have an adverse effect on bone tissue.
In addition, the single nucleotide polymorphisms in various genes encode for proinflammatory proteins, such as IL-1b, IL-6 and IL-8, which may affect biological activity and contribute to hypercoagulability in COVID-19 patients, thereby increasing the risk of bone necrosis. The combination of hypercoagulability, leukocyte aggregation and vasculitis can impair blood flow in the blood vessels of the bone and contribute to the development of bone necrosis.
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