Osteonecrosis of the femoral head (ON) has been recognised as a relatively common complication in patients with systemic lupus erythematosus (SLE) who have received corticosteroids, with a reported prevalence of around 30%.¹ Recently, subchondral insufficiency fracture of the femoral head (SIF) has been reported as a differential diagnosis in patients suspected of having osteonecrosis.^2–4 We describe the clinicopathological features of a patient with SLE with a history of corticosteroid treatment, who developed SIF.

A 55 year old woman had a 32 year history of SLE, which had been treated with corticosteroids (8 mg/day). She had a history of hypothyroidism, arthritis in both shoulders, skin rash, pericarditis, and pleuritis, but had no history of smoking or drinking. The body mass index indicated she was overweight (27.4 kg/m²).

Over the past 5 years she had developed stiffness and discomfort in the right hip, and over the past 2 months the hip pain had got worse. …