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Ann Rehabil Med 2012 Oct; 36(5): 713-718
Early Presentation of Heterotopic Ossification Mimicking Pyomyositis - Two Case Reports -
Yoon-Hee Choi, M.D., Kyoung-Eun Kim, M.D.1, Sung-Hoon Lim, M.D., Jae-Young Lim, M.D.
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, 1Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam 463-040, Korea
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Heterotopic ossification, Pyomyositis, ALP, CRP
Ann Rehabil Med 2012 Oct; 36(5): 713-718

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