Multifocal Osteonecrosis Following Chemotherapy and Short-term Corticosteroid Therapy in a Patient with Small-cell Bronchogenic Carcinoma

This report describes the development of multiple-site, biopsy-proven osteonecrosis in a patient with small-cell bronchogenic carcinoma who had received chemotherapy and short-term administration of corticosteroid. Multifocal osteonecrosis has a wide variety of etiologies, but is most often encountered in the clinical setting of corticosteroid administration, connective tissue disorders, transplantation, hemoglobinopathies and dysbarism. In the oncology patient, chemotherapy, corticosteroids and bone marrow transplantation (with associated preparation therapy) have all been implicated as possible causes. There may be a synergistic effect when corticosteroids are used in combination with chemotherapy and radiation treatment. Multiple periarticular abnormalities appearing on serial radionuclide bone scanning of the cancer patient, particularly when symmetric and in a distribution not suggestive of osseous metastatic disease, raise the possibility of multifocal osteonecrosis. Also to be considered in the differential diagnosis are multifocal infection and polysynovitis/arthritis of other etiology. MRI has a high sensitivity and specificity in the diagnosis of osteonecrosis and should be used when this condition is suspected. Early diagnosis of osteonecrosis is important to prevent irreversible bone and joint destruction.