acenocoumarol and Osteonecrosis

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Topics: Acenocoumarol; Adrenal Cortex Hormones; Adult; Anticoagulants; Antiphospholipid Syndrome; Femur Head Necrosis; Follow-Up Studies; Hip; Humans; Humerus; Knee; Liver Transplantation; Magnetic Resonance Imaging; Male; Osteonecrosis; Periostitis; Radiography; Tarsal Bones; Tibia; Time Factors; Treatment Outcome