RESUMO
INTRODUCTION AND IMPORTANCE: Avascular necrosis (AVN), also known as osteonecrosis, refers to the death of bone tissue due to the lack of blood supply. Osteonecrosis in HIV can be a complication of the ART's or the disease itself. CLINICAL PRESENTATION: 47 years old male, HIV positive for 10 years on Antiretroviral-therapy had gradual onset of bilateral hip pain for 6 months, progressively and sharp in nature, aggravated by movement and relieved by resting with reduced range of movement, wheel chair dependent 2 months. No history of fever, cough, night sweats or weight loss. No history of trauma, steroid use or hormonal therapy and no history of alcohol intake. On Examination he had bilateral inguinal and hip tenderness, pain on movement, with reduced flexion and extension of the hip. His viral-load was 27copies/ml of blood. Complete blood count was unremarkable. Serum lipid panel had no evidence of hypertriglyceridemia. He was diagnosed with bilateral femoral heads Avascular-necrosis. Bilateral ceramic with polyethylene liner uncemented total hip arthroplasty was done. No complications observed, in 6 months of follow up he had Harris hip score of 90 and he had returned to his activities without hip pain complaints/complications. DISCUSSION: The management of AVN is usually total hip arthroplasty, but other surgical treatment includes, hemiarthroplasty, core-decompression and girdle stone arthroplasty, the latter has poor outcomes in-terms of quality of life. CONCLUSION: Understanding causes and mechanism of AVN is crucial for effective management and treatment, particularly when addressing cases such as in our patient with HIV induced osteonecrosis of both femoral heads, surgical treatment should aid on relieving pain and improving patient's quality of life.
RESUMO
INTRODUCTION AND IMPORTANCE: Sclerosing epitheloid fibrosarcoma is a rare variant of low grade sarcoma with specific histologic and immunohistochemical features, and often associated with a poor prognosis. CLINICAL PRESENTATION: We report a case of a 35-year old male who presented with 2 year history of lower back pain, radiating to both lower limbs, weakness to both lower limbs and weight loss more than 5kgs in the past 6 months, no past history of trauma, drenching night sweats, no TB contact history, no incontinence and no any comorbidities. He reported no history of alcohol intake or cigarette smoking, no history of exposure to radiations or similar presentation to his family and no features suggestive of metastasis. On examination - he had maximum midline tenderness L3-S1, no gibbous, upper limbs neurologically intact and power 3/5 to both lower limbs, sensation intact. Computed tomography scan and magnetic resonance imaging revealed an ill-defined osteolytic mass spanning L3 to L5, vertebral plana of L4 and involvement of the left paraspinal muscles. The tumor extended to the extradural space and was also abutting on the distal great vessels. Our intervention entailed laminectomy, tumor debulking and posterior instrumental fusion of the spine. Histopathology findings were in keeping with an invasive sclerosing epitheloid fibrosarcoma. He had adjuvant chemotherapy with good outcome. DISCUSSION: This case was unique due to its lumbar column location, abutting the distal vessels and despite its low grade, it illustrates the malignant potential which responded well to adjuvant chemotherapy. CONCLUSION: Invasive SEF is an aggressive tumor that requires early diagnosis. Multi-modal treatment with surgical resection, adjuvant chemotherapy can improve patient survival and quality of life.
