Dexamethasone-Induced Avascular Necrosis in a Pre-B Acute Lymphoblastic Leukemia Patient: A Case Report

Abstract

Ghulam Mujtaba, Saad Bin Zulfiqar, Rabia Muhammad Wali and Adeel Siddiqui

Avascular necrosis (AVN) poses a significant risk to acute lymphoblastic leukemia (ALL) patients, with the hip joint being the most commonly affected. Systemic corticosteroids, like dexamethasone, contribute to nearly one-third of AVN cases. In our specific case, a 5-year-old male ALL patient, undergoing dexamethasone-based chemotherapy, presented with acute bilateral leg pain. MRI findings confirmed grade 3 avascular necrosis in the right femoral capital femoral region. As a result, dexamethasone was discontinued from the treatment plan, and the patient was discharged with oral pain medication, scheduled for orthopedic follow-ups. This case underscores the importance of close monitoring during systemic corticosteroid use in leukemia treatment. While AVN typically develops over prolonged steroid exposure, our case demonstrates its potential occurrence even after a short course. Early detection improves the prospects for conservative treatment, emphasizing the necessity for awareness and cautious steroid use in ALL therapy.

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