Osteonecrosis of the head of humerus following septic arthritis of the shoulder in a sickle cell disease patient: A sequalae of infection

Abstract

Sickle cell disease (SCD) is the commonest inherited genetic disorder of haemoglobin in individuals of African descent. It is the commonest cause of osteonecrosis in children. The head of the femur and humerus are the most frequently affected sites. Septic arthritis is a well-established complication of SCD in children. Although its pathophysiology in SCD is not completely understood, the roles of impaired immune function, micro vascular occlusion and bone ischaemia are well established. Our index case is a 14 year old known SCD female patient who had arthrotomy and washout of the left shoulder on account of septic arthritis. Two weeks earlier, she was managed for vaso-occlusive crisis with chest painand bone pain in both upper limbs and lower limbs. At 3 months post arthrotomy, she had developed both clinical and radiological features of avascular necrosis of the head of the left humerus. The aim of this report is to advance the need for a multidisciplinary approach in managing vasoocclusive crisis as well as early diagnosis of septic arthritis in SCD based on a high index of suspicion.