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Early presentation of heterotopic ossification mimicking pyomyositis - two case reports -.
[pyomyositis]
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
can
not
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
.
