Session Information
Session Title: AA 2021 Virtual Posters - General Rehabilitation
Session Time: None. Available on demand.
Disclosures: Morgan C. Reynolds: No financial relationships or conflicts of interest
Case Diagnosis: Heterotopic Ossification
Case Description: A 23 year old female without significant medical history was admitted to the hospital with rhabdomyolysis, 6 month history of lip swelling and polyarthralgia. She was diagnosed with systemic lupus erythematous (SLE) and treated with corticosteroids. She developed septic shock, diffuse black scattered lesions over all extremities, and multisystem complications: end stage renal disease and infective endocarditis. She was diagnosed with purpura fulminans (PF) and required intubation, dialysis, antibiotics, and operative excision of necrotic skin lesions. 2 months after her diagnosis with PF, Rehabilitation Medicine was consulted for decreased range of motion (ROM) and pain in the lower extremities. Imaging demonstrated heterotopic ossification (HO) in bilateral knees, which we treated with injection of ketorolac at the right HO site.
Setting: Level 1 Trauma CenterAssessment/
Results: 6 months after initial observation and treatment of HO, the patient demonstrated recovery from PF. Her knee ROM and functional movements had increased and imaging showed a decreased HO burden.
Discussion: HO is a common finding in musculoskeletal, burn, spinal cord (SCI) or traumatic brain injury (TBI). Inflammation plays a key role in HO development after trauma, but there is limited literature linking HO to inflammatory diseases. PF has not been reported as an inciting event for HO. There is limited research on modalities effective for attenuating the development of HO.
Conclusion: Patients with systemic inflammation from conditions such as PF and SLE may experience loss of function, ROM or increased pain due to HO. This case demonstrates that early identification and treatment of HO in similar inflammatory conditions may improve ROM and function in this population in addition to burn, SCI or TBI patients.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Reynolds MC, Loftsgaarden M. Heterotopic Ossification Complicating a Case of Purpura Fulminans: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/heterotopic-ossification-complicating-a-case-of-purpura-fulminans-a-case-report/. Accessed May 9, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/heterotopic-ossification-complicating-a-case-of-purpura-fulminans-a-case-report/