Multilevel Vertebral Body Osteonecrosis in an Adult Patient: A Rare Case with Review of Literature.

Abstract

Osteonecrosis, characterized by ischemic bone injury leading to cell death and bone resorption, manifests in various anatomical sites due to multiple etiologies such as radiotherapy and medications. While certain sites like the femoral head and jaw have garnered attention, vertebral body osteonecrosis remains less explored and lacks a standardized classification system. This report presents a unique case of a 52-year-old woman undergoing chemotherapy for diffuse large B-cell lymphoma who developed multilevel vertebral body osteonecrosis, a rare occurrence in English medical literature. The patient presented with fever, abdominal pain, and lymphoid malignancy markers, initiating chemotherapy with the rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) regimen. During treatment, she experienced breathing difficulties and back pain, prompting imaging studies revealing extensive osteonecrosis affecting multiple vertebrae and other skeletal sites. Various factors, including chemotherapy, human immunodeficiency virus (HIV) therapy, trauma, and others, contribute to vertebral body necrosis. While osteonecrosis in lymphoma patients is rare, chemotherapy-induced marrow necrosis can lead to bone involvement. Vertebral bodies, especially their anterior portions, are susceptible due to limited blood supply. The presence of an intravertebral vacuum cleft on radiographs is pathognomonic for osteonecrosis, while magnetic resonance imaging (MRI) reveals hypointense areas and fluid collections. This case underscores the complexity of diagnosing and managing multilevel vertebral body osteonecrosis, exacerbated by the lack of standardized protocols. The interplay between disease processes and treatment modalities complicates decision-making, emphasizing the need for further research to establish optimal diagnostic and treatment guidelines. In conclusion, this case sheds light on a rare manifestation of osteonecrosis in a lymphoma patient, highlighting the challenges in diagnosis and management. Further research is warranted to enhance understanding and improve outcomes for patients with this debilitating condition.