Heterotopic ossification in a tetraplegic patient with prolonged fever

Abstract

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. 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. 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.