Diminished Bone Marrow Oedema and Healing of Insufficiency Fractures in a HIV Patient after Switching Antiviral Therapies

Abstract

This is a case report about the recurrent onset of bone marrow oedemas and insufficiency fractures in a 64-year-old male Human Immunodeficiency Virus (HIV)-patient, who was going through an antiviral treatment. The patient experienced stress-related pain and swelling in both ankle joints and feet, and was treated antivirally with Atripla® for several years. Therapeutically, conservative treatment as well as a therapeutic trial with bisphosphonates were performed. As a result of developing renal insufficiency, antiviral therapy was switched to a combination of Prezista® and Norvir®. Only after switching the antiviral therapy, there was a clear clinical improvement of the symptoms. The clinical symptoms correlated well with Magnetic Resonance Imaging (MRI), the features of which are detectable regressive bone marrow oedemas and the healing of insufficiency fractures. The impaired renal function improved to a compensated retention. In the case of HIV patients with unclear joint complaints, the presence of bone marrow oedema should be considered.

Keywords

• bone marrow oedema syndrome
• fatigue fracture
• human immunodeficiency virus
• medical therapy
• renal insufficiency
• tenofovir