Simultaneous bilateral avascular necrosis of the humerus and femur in long COVID-19: a case report

Background. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted the widespread use of corticosteroids as a treatment strategy, particularly in cases of severe pneumonia and cytokine storm. While this therapy has saved countless lives, its side effects have also been well-documented, including the development of avascular necrosis.

Case presentation. This case report presents a rare instance of simultaneous bilateral avascular necrosis (AVN) affecting both the humeral and femoral heads in a 49-year-old male patient recovering from severe COVID-19. The patient was treated with high-dose corticosteroids, receiving 1250 mg of prednisolone over five days during hospitalization for COVID-19 pneumonia. Six months after discharge, he developed persistent hip pain, which was later diagnosed as AVN in both femoral heads. During hyperbaric oxygen therapy, the patient reported new shoulder pain, and MRI confirmed stage III AVN in both humeral heads. The patient’s pain was managed with bilateral suprascapular nerve radiofrequency ablation and bilateral Pericapsular Nerve Group (PENG) blocks, which provided significant relief.

Conclusions. This case emphasizes the potential for corticosteroid-induced AVN, even months after treatment, and underscores the need for long-term monitoring of patients receiving corticosteroids for COVID-19. The involvement of four major joints highlights the severe musculoskeletal complications that can arise, supporting the importance of early diagnosis and timely intervention for pain relief.