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Extensive progressive heterotopic ossification post-Covid-19 in a man
María Lorena Brance1, Nicolás M Cóccaro2, Araceli N Casalongue3
1Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina; Reumatología y Enfermedades Óseas Rosario, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
A severe COVID-19 infection triggered extensive heterotopic ossification (HO) in a 55-year-old man. Genetic testing for fibrodysplasia ossificans progressiva (FOP) was negative, suggesting a novel post-viral HO etiology.
Area of Science:
- Orthopedics
- Genetics
- Infectious Diseases
Background:
- Heterotopic ossification (HO) involves extraskeletal bone formation, often linked to trauma or genetic disorders like fibrodysplasia ossificans progressiva (FOP).
- SARS-CoV-2 infection (COVID-19) has been anecdotally associated with HO exacerbation, but the mechanisms remain unclear, with potential roles for immobilization and inflammation.
Observation:
- A 55-year-old man developed severe, progressive heterotopic ossification across multiple joints following a significant COVID-19 illness.
- The patient presented with clinical features suggestive of late-onset atypical FOP, including painful swelling and bilateral congenital hallux valgus.
Findings:
- Despite clinical suspicion for FOP, genetic analysis of the ACVR1 gene revealed no significant variants or structural abnormalities.
- This case highlights a potential link between severe SARS-CoV-2 infection and the development of extensive HO, independent of known FOP genetic mutations.
Implications:
- Severe COVID-19 may trigger or exacerbate heterotopic ossification through mechanisms beyond typical FOP pathways.
- Further research is needed to elucidate the etiopathogenesis of post-viral HO and its distinction from genetic forms like FOP.
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