Heterotopic ossification in a tetraplegic patient with prolonged fever

Abstract

Objective: Prolonged fever is rare in patients with spinal cord injury. Fever has been shown to be associated with hetero-topic ossification, but prolonged fever is very rare. We report here a case of prolonged fever in a tetraplegic patient who was eventually diagnosed with heterotrophic ossification, and provide a review of the literature. Treatment with sodium etidronate resolved the fever.

Case report: A 51-year-old man with C3 tetraplegia developed prolonged fever (37.5-39.4°C). Fever workup did not reveal a definite origin of the fever. Non-infectious disease was suspected. The patient was diagnosed with heterotopic ossification after 3-phase bone scintigraphy. Oral sodium etidronate treatment was started immediately at a dose of 20 mg/kg/day after diagnosis. On the 14th day of administration, the patient's body temperature decreased to the normal range and remained stable.

Conclusion: Heterotopic ossification should be taken into consideration when examining patients with spinal cord injury who have prolonged fever. This case shows that hetero-topic ossification can be treated successfully with sodium etidronate.