First Case Report of Bilateral Avascular Necrosis in an Eosinophilic Esophagitis Patient on Swallowed Fluticasone

Avascular necrosis (AVN) of the femoral head is a rare complication that can be associated with prolonged use of glucocorticoids. On reviewing the literature, this is the first case of bilateral AVN secondary to the long use of topical steroids in an eosinophilic esophagitis (EoE) patient. A 28-year-old man presented to our gastroenterology clinic for worsening fibrostenotic (EoE) despite being on swallowed fluticasone administered through an inhaler for seven years. The latter was stopped, and the patient was commenced on dupilumab. The patient was referred to orthopedics to manage his limping and groin pain. Bilateral hip replacements were performed when bilateral AVN was confirmed on MRI of both hips. The patient's EoE symptoms resolved after endoscopic dilation and an ongoing course of dupilumab. Furthermore, dupilumab showed an excellent control of the disease activity based on esophageal biopsies. To our knowledge, this is the first case report of such an entity. Our case highlights the need to promote awareness of such serious side effects of prolonged use of topical corticosteroids among healthcare providers, even if administered through a metered inhaler.