A 28 year old male patient, known case of pemphigus vulgaris was on dexamethasone pulse
therapy. Total 7 pulses were given after that he developed avascular necrosis of head of femur on both
sides, which was confirmed by digital X- ray and MRI. Avascular necrosis is a disabling and
progressive condition in young patients gradually leads to femoral head collapse and eventual total hip
arthroplasty. As per WHO-UMC causality assessment criteria, the association between reaction and
drug was possible, Naranjo’s score was 7. According to Modified Schumock and Thornton’s criteria,
this reaction was not preventable. The Modified Hartwig and Siegel’s scale showed that the reaction
was severe (level 6). Here we present a case where the use of steroid for pemphigus vulgaris resulting
in the development of bilateral avascular necrosis of head of femur.
Keywords: Corticosteroids, avascular necrosis, osteonecrosis, dexamethasone.
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