Known case of systemic lupus erythematosus, on treatment, presented with ankle pain.
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There are irregular serpiginous lines in medulla of distal tibia, fibula and posterior calcaneus. These lines appear hyperintense in T1 fat sat images in parallel with the hypointense thin lines within the marrow, suggestive of bone infarction.
Medullary bone infarction is a complication of long term steroid therapy in SLE patients.