A Case Report on Steroid-Induced Avascular Necrosis Treated with Autologous Adult Live-Cultured Osteoblasts (AALCO) in COVID-19 Patients (preprint)

ABSTRACT

In the absence of a targeted antiviral agent effective against COVID-19, corticosteroids show improvements in hyperinflammation and acute respiratory distress syndrome (ARDS) associated with COVID-19. However, various adverse effects of corticosteroids have been reported, like delayed viral clearance, secondary infections, avascular necrosis and suppression of the hypothalamic-pituitary-adrenal axis. In this case report, we report clinical outcomes in two patients with symptomatic avascular necrosis (AVN) of the femoral head after being treated with corticosteroids for COVID-19. We implanted autologous adult live-cultured osteoblasts (AALCO), sourced from mesenchymal stem cells via bone marrow aspiration, for treating AVN in both patients. The MRI examination suggested steroid-induced AVN of the hip with Ficat-Arlet stage IIB in these patients. A prednisone (corticosteroid) was used during COVID-19 treatment for a mean treatment duration of 14.5 days. The AALCO implantation showed good clinical outcomes in treating steroid-induced AVN of the hip with Ficat-Arlet stage IIB in both patients with COVID-19.