Age / Sex : 47 / F

C.C: Pelvic pain/ Back pain

PHx:
Underlying SLE and antiphospholipid syndrome
Left temporal lobe의 acute cerebral infarction으로 입원
입원 중 fever와 pancytopenia 지속되었고 hemophagocytic lymphohistocytosis (HLH) 진단되어 chemotherapy 시행.
입원후 한달후부터 both pelvic pain/back pain 호소



What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy : 이승훈 (Seunghun Lee), 한양대학교병원 (Hanyang University Hospital)

Osteonerosis

Discussion

Osteonerosis
The death of marrow elements and osteocytes due to compromise of vascularity of the bone.
- Avascular necrosis : subchondral bone of an epiphysis involvement
- Bone infarct : diaphyseal or metaphyseal involvement

MRI findings
Enhanced area : T1 low SI, T2 intermediate to high SI
Nonenhnaced area : T1/T2 low SI
- Histologic correlation : enhanced and nonenhanced areas corresponded respectively to viable and necrotic tissue.


Hemophagocytic lymphohistiocytosis (HLH)
A rare and potentially life-threatening disorder that affects the immune system.
Charaterized by hemophagocytosis within the marrow, uncontrolled activation of T cells and macrophages, and overproduction of inflammatory cytokine

References
Vande Berg, B et al. Radiology vol. 182,2 (1992): 445-504