Early Presentation of Heterotopic Ossification Mimicking Pyomyositis: Two Case Reports.
10.5535/arm.2012.36.5.713
- Author:
Yoon Hee CHOI
1
;
Kyoung Eun KIM
;
Sung Hoon LIM
;
Jae Young LIM
Author Information
1. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea. drlim1@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Heterotopic ossification;
Pyomyositis;
ALP;
CRP
- MeSH:
Abscess;
Alkaline Phosphatase;
Biomarkers;
C-Reactive Protein;
Cellulitis;
Creatine Kinase;
Early Diagnosis;
Hydrazines;
Ossification, Heterotopic;
Osteomyelitis;
Physical Examination;
Pyomyositis;
Thrombophlebitis;
Venous Thrombosis
- From:Annals of Rehabilitation Medicine
2012;36(5):713-718
- CountryRepublic of Korea
- Language:English
-
Abstract:
Early diagnosis and treatment of heterotopic ossification (HO) is essential to the prevention of complications. It is difficult to diagnose HO in its initial phase because non-specific clinical manifestations, laboratory findings and imaging findings of immature HO may mimic other diseases such as cellulitis, osteomyelitis, thrombophlebitis, deep vein thrombosis and local infection with abscess. We experienced two cases of HO, which were misdiagnosed as pyomyositis at first by clinical signs and MRI findings indicating the deep infection; the extensive intramuscular ossification appeared later on. We observed an increase of C-reactive protein and creatine kinase followed by the elevation of alkaline phosphatase with abnormal triphasic bone scan. The trajectory of these biomarkers was analyzed to get more insight into the early stages of HO along with the imaging findings. Although our cases cannot be generalized as typical of immature HO, they clearly demonstrate that the change of specific biomarkers with a careful history taking and physical examination should be noted to detect HO as early as possible while avoiding confusion with other mimicking conditions.
