Prolonged fever and heterotopic ossification in a C4 tetraplegic patient. Case report

Abstract

Prolonged fever is an uncommon diagnostic problem in a spinal cord injury patient. The underlying causes include recurrent infections, thromboembolic phenomena and central fever. We report a case of heterotopic ossification in a traumatic C4 tetraplegic patient presenting as prolonged fever of 3 months' duration. Treatment with oral indomethacin led to prompt resolution of the fever and acute manifestations of heterotopic ossification. The efficacy of indomethacin in the treatment of heterotopic ossification in spinal cord injury needs to be further confirmed in larger studies.

Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury

“…The importance of the autonomic nervous system for soft tissue inflammation and bone disposition may be much greater than presumed thus far. 20,21 The combination of a high positive and high negative predictive value for autonomic dysregulation seems to suggest a causal relationship.…”

Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review

“…1 , 2 , 3 , 4 , 5 The most common identifiable cause of fever is urinary tract infection. 1 , 3 , 4 , 6 , 7 , 8 , 9…”

Neurogenic heterotopic ossification in spinal cord injury

“…10,54 Peri-articular erythema and warmth may also occur, sometimes accompanied by a low-grade fever. 55 Spasticity may increase secondary to the NHO development. 53 Reduction of hip joint movement and spasticity may lead to loss of an adequate sitting position, 51 pressure sores, and related pain complaints 52 and may also compromise transfers and activities of daily living.…”