COVID-19–Associated Bone Marrow Necrosis—A Case Report

Ghosh, Soumyadeep; Gupta, Santosh; Mehta, Nirad; Khodaiji, Shanaz

doi:10.1055/s-0041-1735919

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…Four studies [ 50 , 51 , 53 , 54 ], overall involving 228 patients, focused on AVN of the hip, and two studies (5 patients) [ 47 , 48 ] focused exclusively on the knee. The other studies included patients with AVN deriving from mixed areas of the body (spine, pelvis, shoulder) [ 49 , 52 , 55 ]. Study generalities and data of the patients are shown in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

Migliorini,

Maffulli,

Shukla

et al. 2024

J Orthop Surg Res

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Background In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and characterises the trend of AVN following time-limited high-dose CCS administration in patients who had severe COVID-19, discussing management strategies and outcomes. Methods This systematic review was conducted according to the 2020 PRISMA statement. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Scopus restricting the search to the years 2019 to 2023. All the clinical studies which investigated the association between time-limited high-dose CCS administration in patients with severe COVID-19 infection and AVN were accessed. Results A total of 245 patients (9 studies) who experienced AVN following COVID-19 were included in the present investigation. 26% (63 of 245 included patients) were women. The mean age of the patients was 42.9 ± 17.7 years. Four studies focused on AVN of the hip and two on the knee, and the other studies included patients with AVN from mixed areas of the body (spine, pelvis, and shoulder). The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was 79.4 ± 59.2 days (range, 14 to 166 days). Conclusion It is possible that even time-limited high-dose CCS administration in patients with severe COVID-19 infection increased the incidence of AVN. The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was approximately 80 days. Given the high risk of bias in all the included studies, the quality of recommendations of the present investigation is low, and no reliable conclusion can be inferred.

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Section: Resultsmentioning

confidence: 99%

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

Migliorini,

Maffulli,

Shukla

et al. 2024

J Orthop Surg Res

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“…A coagulopathy has been reported in up to 50% of patients with severe COVID-19 manifestations [ 4 ]. Infection-induced endothelial dysfunction causes an excess of procoagulant thrombin with concomitant shutting down of the fibrinolytic cascade resulting in a hypercoagulable state which can spur thrombosis by increasing blood viscosity and coupled with hypoxia can activate the hypoxia-induced transcription factor-dependent signalling [ 5 ]. SARS-CoV-2 ORF3a protein and host hypoxia-inducible factor (HIF-1Þ) play key role in the virus infection and pro-inflammatory responses.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of metaphyseal osteonecrosis of humerus in a post covid patient: a case report

Thankappan¹,

Nasimudeen²,

Thomas³

et al. 2022

Pan Afr Med J

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Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the post-operative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for non-traumatic osteonecrosis among other reported causes of osteonecrosis.

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“…Moreover the virus binds to the angiotensin-converting enzyme 2 (ACE-2) receptors and leads to activation and redistribution of immune cells [32][33][34][35]. There have been many references in the literature regarding the development of autoimmune diseases including granulomatous diseases as well as bone marrow involvement in patients following COVID-19 [36][37][38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis in A Post Covid-19 Patient with Mds: A Case Report

Vasilopoulos¹,

P²,

Kalliope³

et al. 2022

Int J Blood Res Disord

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Primary or secondary hemophagocytic lymphohistiocytosis (HLH) is characterized by immune activation and lifethreatening cytopenias. Causative relationship between a number of pathogens, autoimmune diseases and even hematologic malignancies with secondary HLH (sHLH) have been reported; however, correlation with myelodysplastic syndromes (MDS) is exceedingly unusual. HLH in COVID-19 positive patients has been described. Nevertheless, patients who have recovered after COVID-19 infection and test negative for the virus by RT-PCR may develop sHLH due to immune system dysregulation. We present here a rare case of sHLH manifestation after COVID-19 infection in a patient with a history of MDS. The recently revised H-score contributed to diagnosis.

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COVID-19–Associated Bone Marrow Necrosis—A Case Report

Cited by 11 publications

References 4 publications

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

An unusual case of metaphyseal osteonecrosis of humerus in a post covid patient: a case report

Hemophagocytic Lymphohistiocytosis in A Post Covid-19 Patient with Mds: A Case Report

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