Avascular necrosis in systemic sclerosis patients: a case-based review of demographics, presentation, and management

Avascular necrosis (AVN) is a pathologic process involving death of bony tissue resulting from loss of blood supply from various causes. Various traumatic and nontraumatic causes of AVN are known, including systemic autoimmune diseases. AVN has been well described in patients with autoimmune diseases such as systemic lupus erythematosus, but in systemic sclerosis (SSc) patients, there have been limited case reports and case series. There have only been three case reports of AVN in multiple anatomic sites (multifocal AVN) reported in SSc patients in the literature. We present a case of multifocal AVN in an SSc patient and a review of literature on the previously reported cases of SSc-related AVN in terms of demographics, clinical presentation, and management. To our knowledge, this is the only literature review of reported AVN cases in SSc patients.