J Rheum Dis.  2013 Jun;20(3):186-189. 10.4078/jrd.2013.20.3.186.

A Case of Bone Marrow Edema Syndrome in a Patient with Anti-phospholipid Syndrome

• Lee KE
• Park HB
• Kang JH
• Park DJ
• Kim TJ
• Park YW
• Shin HH
• Lee SS

• KMID: 2222759
• DOI: http://doi.org/10.4078/jrd.2013.20.3.186

Abstract

Bone marrow edema is a common and nonspecific finding on magnetic resonance imaging (MRI) and results from various diseases including infection, inflammation, neoplasm, injury, and osteoarthritis. However, bone marrow edema syndrome (BMES) represents a distinct entity with specific clinical and imaging features such as diffuse extensions, the lack of other morphologic alterations, no history of trauma, and reversible disease courses. BMES is caused by ischemic changes, and thus, it is postulated to occur as a result of the thrombosis in a patient with primary anti-phospholipid syndrome (APS). Here, we present a case of 67-year-old male with a history of stroke, being presented with fever of unknown origin and pain on both knees. He had high titers of IgG and IgM anti-cardiolipin antibodies which titers didn't change after 3 months. He was diagnosed as having a BMES due to typical MRI findings. After the introduction of anticoagulation, fever and joint pain were subsided. Our case suggests that BMES can develop within a patient with APS, thus early detection of differentiations is essential to avoid unnecessary treatments.

Keyword

Bone marrow edema syndrome; Antiphospholipid syndrome; Anticoagulation

MeSH Terms

Antibodies
Antiphospholipid Syndrome
Arthralgia
Bone Marrow
Edema
Fever
Fever of Unknown Origin
Humans
Immunoglobulin G
Immunoglobulin M
Inflammation
Knee
Magnetic Resonance Imaging
Male
Osteoarthritis
Stroke
Thrombosis
Antibodies
Immunoglobulin G
Immunoglobulin M

Figure

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  Figure 1. Coronal (A) and sagittal (B) proton density fat-suppressed images of the left knee showing heterogenous increased signal intensity in the patella, bilateral femoral and tibial condyles.

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  Figure 2. Magnetic resonance images of the left knee five years later. Coronal (A) and sagittal (B) T1-weighted images and coronal (C) and sagittal (D) fat-suppressed T2-weighted images showing normal signal intensity.

Reference

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