A 27-year-old woman complains of constant back pain. She recently had an episode of severe chest and back pain that required narcotic medications, blood transfusions, and lots of fluids to treat. On examination, she is afebrile, with midthoracic tenderness on palpation. X-rays of the spine reveal periosteal reaction of the eighth thoracic vertebra. She has a chronic blood disorder where bone infarction can occur that may be difficult to distinguish from osteomyelitis.For the above patient with a hemoglobin abnormality, select the most likely diagnosis.
In sickle disease, if the bone infarction occurs in proximity to a joint, an effusion can develop. The underlying pathology is a vasoocclusive phenomenon. Bone infarction can appear like osteomyelitis (radiographically and clinically), which is problematic since patients with sickle cell disease are also at increased risk of osteomyelitis.
beta-thalassemia major
HbH disease
sickle cell disease
HbC disease
Blood