Osteonecrosis of the distal tibia in systemic lupus erythematosus: A rare case report

Ihsan Oesman, Danarto Hari Adhimukti

Research output: Contribution to journalArticlepeer-review


Introduction: Osteonecrosis (ON) is characterized by cellular death of bone components due to interruption of blood supply that leads to bone ischemia and potential joint destruction. There are multiple risk factors and medical condition associated with ON, including systemic lupus erythematosus (SLE). The most common sites of ON are the femoral head, distal femur, proximal humerus, talus and lumbar spine. Very few cases of nontraumatic ON in distal tibia have been reported in the literature. Case Illustration: We present a case of 23-year-old female diagnosed with osteonecrosis of distal tibia and history of SLE. The patient also had history of avascular necrosis of right hip and underwent right total hip arthroplasty. We treated the patients with conservative treatment for intial management. Discussion: The risk of ON in SLE patients is likely due to the results of both the SLE itself and use of corticosteroids. Systemic inflammation in SLE reduces the development of osteoblasts, increases osteoclast maturation and activity and increases protohrombotic agents that can lead to rapid bone loss. Corticosteroids are the most consistent risk factor associated with the development of ON in SLE. Conservative medical management is effective in the early stages of the disease before bone collapse. Conclusion: Despite advances in the diagnosis and treatment of SLE, symptomatic ON continues to be a significant comorbidity. Strategies to detect and manage early stage ON is necessary to prevent the progression of this serious complication.

Original languageEnglish
Pages (from-to)126-128
Number of pages3
JournalInternational Journal of Surgery Case Reports
Publication statusPublished - Jan 2020


  • distal tibia
  • osteonecrosis
  • systemic lupus erythematosus


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