Heterotopic ossifications in patients post SARS-CoV infection: case report and literature review

master's thesis

• Title (croatian): Heterotopične osifikacije nakon SARS-CoV infekcije: prikaz slučaja i pregled literature
• Author: Peter Papič
• Mentor: Tomislav Smoljanović (mentor)
• Committee member: Tomislav Smoljanović (predsjednik povjerenstva)
• Committee member: Domagoj Delimar (član povjerenstva)
• Committee member: Ivan Bohaček (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Heterotopic ossification (HO) is defined as the ectopic formation of lamellar bone in extraskeletal tissues. It can cause pain, redness, warmth, swelling, and limited range of motion at the affected site, significantly reducing patients' quality of life. HO most commonly occurs after mechanical trauma, burns, traumatic brain injury, and various orthopedic surgical procedures. Why HO occurs hasn’t been proven, but it has been hypothesized to be connected with an increase in inflammatory markers causing the differentiation of mesenchymal stem cells into osteoprogenitor cells. Since the beginning of the global coronavirus disease 2019 (COVID-19) pandemic officially declared by the World Health Organization on May 11th, 2020, numerous authors have reported a possible correlation between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and increased risk of formation of HO. A report of a patient who developed HO in hip and knee regions following severe SARS-CoV-2 infection is provided together with a literature review related to the subject. This literature review included 42 patients who experienced HO after being admitted to the intensive care unit and receiving mechanical ventilation due to SARS-CoV-2 infection. Out of the 32 patients whose HO locations were identified, the hip joint was affected in 22 patients (68.8%), making it the most prevalent area affected. Surgical excision of the HO was reported for 13 patients. For the remaining patients, conservative, non-surgical treatments were utilized, which resulted in significant relief. A common denominator between these cases of ectopic bone growth after COVID-19 infection was analysed. It is considered that the occurrence of HO following SARS-CoV-2 infection is due to the increase in inflammatory markers connected to prolonged hospitalization in the intensive care unit, lack of mobility and mechanical ventilation, and associated metabolic disturbances, but confirmation requires additional research.

Abstract (croatian)

Heterotopična ossifikacija (HO) definirana je kao ektopična formacija laminarne kosti u ekstra-skeletnim tkivima. To može uzrokovati bol, crvenilo, toplinu, oticanje i ograničen raspon pokreta u zahvaćenom području, značajno smanjujući kvalitetu života bolesnika. Najčešće se HO javlja nakon mehaničke traume, opeklina, traumatske ozljede mozga i raznih ortopedskih kirurških postupaka. Zašto se HO javlja nije dokazano, ali se hipotetiziralo da je povezano s povećanjem upalnih markera koji uzrokuju diferencijaciju mezenhimalnih matičnih stanica u osteoprogenitorske stanice. Od službenog proglašenja globalne koronavirus bolesti 2019 (eng. coronavirus disease 2019 (COVID-19)) pandemije od strane Svjetske zdravstvene organizacije 11. svibnja 2020. godine, nekoliko autora izvijestilo je o mogućoj povezanosti između teškog akutnog respiratornog sindroma uzrokovanog koronavirusom 2 (eng. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) infekcije i povećanog rizika formacije HO. Prikazan je slučaj bolesnika u kojega su se razvile HO u području kukova i koljena nakon preboljenja teškog oblika SARS-CoV-2 infekcije zajedno s pregledom literature iz te tematike. Ovaj pregled literature obuhvatio je 42 pacijenta koji su razvili HO nakon što su bili primljeni na intenzivnu njegu i primali mehaničku ventilaciju zbog infekcije SARS-CoV-2. Zglob kuka bio je najčešće pogođeno područje od strane HO, zahvaćajući 22 od ukupno 32 (68,8%) pacijenata čije su lokacije HO-a bile prikazane. Kirurško uklanjanje HO učinjeno je kod 13 pacijenta. Za preostale pacijente primjenjivane su konzervativne, nekirurške terapije koje su rezultirale značajnim olakšanjem. Analiziran je zajednički uzročnik nastanka HO nakon COVID-19 infekcije. Smatra se da je pojavnost HO nakon SARS-COV-2 infekcije povezana s povećanjem upalnih čimbenika tijekom produljene hospitalizacije u jedinici intenzivne njege, nedostane pokretljivosti i mehaničke ventilacije s povezanim metaboličkim poremećajima, ali potvrda tih sumnji zahtijeva dodatna istraživanja.

• Keywords: heterotopic ossification; SARS-CoV-2; COVID-19 infection; mechanical ventilation; intensive care unit; inflammation
• Keywords (croatian): heterotopične osifikacije; SARS-CoV-2; COVID-19 infekcija; mehanička ventilacija; jedinica intenzivne njege; upala
• Language: english
• URN:NBN: urn:nbn:hr:105:237809
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-09-01 11:41:12