A vascular necrosis of both hips and knees in a patient with ulcerative colitis treated for a long term with high-dose corticosteroids

INTRODUCTION: Avascular necrosis represents the bone tissue death from vascularization failure, and it is mainly associated with the use of high-dose corticosteroids for a long time. CLINICAL CASE: A 25 years old female patient treated with high-dose corticosteroids for 7 months for ulcerative colitis presents with both knees pain and limited hip and knee motility. In a plain X-ray and in nuclear magnetic resonance imaging (MRI) avascular necrosis was observed at these joints. Bone densitometry showed osteopenia at the femoral head and lumbar osteoporosis. DISCUSSION: We present a striking case for its large involvement of the joints (both knees and hips) with simultaneous osteoporosis and osteopenia in a young patient treated with corticosteroids for ulcerative colitis. It is necessary to recommend the judicious use of glucocorticoids, prescribing the minimal necessary dose and for the least amount of time necessary to control the underlying disease.