Rhabdomyolysis after heterotopic ossification: an unusual complication in a spinal cord injured patient

Loss of joint mobility, resulting loss of function peripheral nerve entrapment and pressure sores are the known complications of heterotopic ossification.We reported about a 32-year-old male patient, referred to our clinic presenting with incomplete tetraplegia after a motorcycle accident. The patient developed a HO in both hips 19 days after injury. Single-dose radiation therapy with 7 Gy with an electrode voltage of 15 MeV was performed.One month after radiation therapy, the patient developed a fever of 104ºF and blood tests showed increased C-reactive protein (CRP), creatinine kinase (CK), serum myoglobin and dark-colored urine due to myoglobinuria. Further diagnostic measures showed only massive recurrent HO. With the suspicion of a possible case of rhabdomyolysis due to the severe muscular distension caused by the recurrent HO, the patient was transferred to our intermediate care unit for further treatment. Forced diureses were applied to reduce the high levels of CK in blood. However, laboratory monitoring showed a further increase in CRP, CK (15,000 U/l) and myoglobin. A repeated radiation therapy was undertaken in a time interval of 14 days. After radiation therapy, a control MRI was performed and no signs of florid HO were visualized, CRP, CK, myoglobin, as well as body temperature and urine colour, had returned to normal and the patient was feeling well.We report the case of our patient to increase awareness among physicians and training staff working with patients with a spinal cord injury to expedite the diagnosis of rhabdomyolysis in the setting of HO and SCI.