833 - Hidden in the Hip: Unmasking Avascular Necrosis in Alcohol use disorder with Pancreatitis

Bilateral avascular necrosis (AVN) of the hips in a 34-year-old male with a history of alcohol use disorder, initially presenting with acute pancreatitis and seizures. 

Case Description:

A 34-year-old male with a history of alcohol use disorder, multiple sclerosis, and seizure disorder was admitted for acute pancreatitis and generalized tonic-clonic seizures. Following treatment and resolution of initial symptoms, he was transferred to an inpatient rehabilitation facility. Despite improvement in his presenting conditions, the patient exhibited poor participation in physical therapy due to persistent, severe hip pain. Given his history of chronic alcohol abuse, AVN was suspected. Magnetic resonance imaging confirmed bilateral AVN of the hips.

Discussions:

This case highlights the importance of considering AVN in patients with a history of chronic alcoholism, particularly when they present with unexplained hip pain during rehabilitation for seemingly unrelated conditions. The association between chronic alcohol abuse, pancreatitis, and AVN is noteworthy. Early diagnosis of AVN is crucial, as delayed recognition can lead to disease progression and potential bone collapse. This case underscores the need for a high index of suspicion and appropriate imaging studies in at-risk patients, even when initial presenting complaints may not directly suggest hip pathology.

Conclusions:

Clinicians should maintain a low threshold for investigating persistent hip pain in patients with a history of alcohol use disorder and chronic steroid use especially during rehabilitation for other conditions. Early diagnosis of AVN through appropriate imaging can significantly impact treatment outcomes and prevent further complications. This case emphasizes the importance of comprehensive evaluation in patients with a history of alcohol abuse presenting with multisystem complaints.