Avascular necrosis of bilateral femoral head in a HIV patient

Abstract

Avascular necrosis (AVN) is due to ischemic death of the bone involving typically the femoral heads. Its incidence rate is higher in HIV-infected patients and is multifactorial. The factors such as dyslipidemia, alcohol use, steroid use, protease inhibitor in highly active anti-retroviral therapy (HAART) regimen and HIV infection itself increases the incidence of AVN. Here, we report the case of 52-year-old female with a history of pain in bilateral hip joint with no history of trauma. She was a known case of retroviral disease since 9 years and was on HAART. On examination, her vitals were stable, and she had restriction in both passive and active movements around bilateral hip joint, and they were painful. There was no obvious swelling, and other joints were normal. General and systemic examinations, including neurological and musculoskeletal, were normal. Laboratory parameters showed hematological renal and liver functions to be normal, but total cholesterol was 285 mg/dl and triglycerides were 231 mg/dl. Magnetic resonance imaging showed STIR hyperintense band sign corresponding to T1 hypointense rim suggestive of bilateral AVN of head of femur (FICAT and ARLET Classification Stage 1). The aim of this case report is to alert the clinicians involved in HIV care regarding AVN as a subtle yet frequent complication in a HIV-infected patient with known predisposing factors when presenting with acute spontaneous nontraumatic bilateral hip joint pain.