Medullary bone infarct - lupus on corticosteroids

Case contributed by Dr Matt Skalski

Presentation

Ankle pain in a patient with known systemic lupus erythematosus being treated with corticosteroids.

Patient Data

Age: 35 years old
Gender: Male

Aside from a small talar ridge and moderate osteopenia, the study is unremarkable. 

There are irregular, serpiginous lines of low T1 and STIR signal intensity observed within the medullary space of the distal tibia and posterior calcaneus. On STIR, there is a hyperintense line pralleling the inner surface of the hypointense line within the marrow. 

Case Discussion

Medullary bone infarcts and avascular necrosis are common complications of aggressive or long-term steroid therapy. Diseases such as lupus are commonly treated with corticosteroids, and the clinician and radiologist must be vigilant in their evaluation for this complication. 

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