Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report
Background Paroxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains...
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| Veröffentlicht in: | Surgical Case Reports 2020-11, Vol.6 (1), p.293-293, Article 293 |
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| creator | Sato, Takeaki Watanabe, Mayo Onoda, Yoshito Oyanagi, Taku Kushimoto, Shigeki |
| description | Background
Paroxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains unelucidated. Vitamin D deficiency is a common abnormality among critically ill patients and may be associated not only with musculoskeletal complications, but also with high morbidity and mortality. The association between vitamin D deficiency and HO in patients with PSH has not yet been evaluated.
Case presentation
A 21-year-old man was in a motorcycle accident. The initial diagnosis was diffused axonal injury, thoracic aortic injury, bilateral lung contusion with hemopneumothorax, liver injury, vertebral injury of T5, along with fractures of the right humerus, left patella, bilateral scapula, and a stable pelvic fracture, with an Injury Severity Score of 50. Two weeks after admission, he was diagnosed with PSH. One month after the injury, decreased joint mobility and progressive pain were evident. Computed tomography (CT) showed HO in his humerus, ulna, radius, scapula, ilium, pubis, ischium, knee joint, patella, and tibia, as well as renal calculus. To evaluate metabolic bone abnormalities, we measured levels of 25-OH vitamin D, parathyroid hormone, calcitonin, procollagen type I N-terminal propeptide (a marker of bone formation), and tartrate-resistant acid phosphatase 5b (a marker of bone resorption). This revealed a vitamin D deficiency. Bisphosphonate agents and vitamin D were administered for 1 month. Thereafter, his symptoms, radiographic findings, and laboratory abnormalities improved, and he was transferred to another facility.
Conclusions
HO in patients with PSH, following severe head injury, may be associated with vitamin D deficiency. Medication for vitamin-D-related metabolism abnormalities may represent a novel intervention for HO with PSH. |
| doi_str_mv | 10.1186/s40792-020-01031-4 |
| format | Article |
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Paroxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains unelucidated. Vitamin D deficiency is a common abnormality among critically ill patients and may be associated not only with musculoskeletal complications, but also with high morbidity and mortality. The association between vitamin D deficiency and HO in patients with PSH has not yet been evaluated.
Case presentation
A 21-year-old man was in a motorcycle accident. The initial diagnosis was diffused axonal injury, thoracic aortic injury, bilateral lung contusion with hemopneumothorax, liver injury, vertebral injury of T5, along with fractures of the right humerus, left patella, bilateral scapula, and a stable pelvic fracture, with an Injury Severity Score of 50. Two weeks after admission, he was diagnosed with PSH. One month after the injury, decreased joint mobility and progressive pain were evident. Computed tomography (CT) showed HO in his humerus, ulna, radius, scapula, ilium, pubis, ischium, knee joint, patella, and tibia, as well as renal calculus. To evaluate metabolic bone abnormalities, we measured levels of 25-OH vitamin D, parathyroid hormone, calcitonin, procollagen type I N-terminal propeptide (a marker of bone formation), and tartrate-resistant acid phosphatase 5b (a marker of bone resorption). This revealed a vitamin D deficiency. Bisphosphonate agents and vitamin D were administered for 1 month. Thereafter, his symptoms, radiographic findings, and laboratory abnormalities improved, and he was transferred to another facility.
Conclusions
HO in patients with PSH, following severe head injury, may be associated with vitamin D deficiency. Medication for vitamin-D-related metabolism abnormalities may represent a novel intervention for HO with PSH.</description><identifier>ISSN: 2198-7793</identifier><identifier>EISSN: 2198-7793</identifier><identifier>DOI: 10.1186/s40792-020-01031-4</identifier><identifier>PMID: 33226506</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alfacalcidol ; Brain ; Calcifediol ; Case Report ; Case reports ; Injuries ; Medicine ; Medicine & Public Health ; Phosphatases ; Physiological aspects ; Surgery ; Vitamin D ; Vitamin D deficiency ; Vitamin deficiency</subject><ispartof>Surgical Case Reports, 2020-11, Vol.6 (1), p.293-293, Article 293</ispartof><rights>The Author(s) 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-dddee0fe52439eb817eeaed659f3ef9cd40dfa0bfc7fecf48e999477637eb27f3</citedby><cites>FETCH-LOGICAL-c472t-dddee0fe52439eb817eeaed659f3ef9cd40dfa0bfc7fecf48e999477637eb27f3</cites><orcidid>0000-0002-6154-2968</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683749/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683749/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,41096,41464,42165,42533,51294,51551,53766,53768</link.rule.ids></links><search><creatorcontrib>Sato, Takeaki</creatorcontrib><creatorcontrib>Watanabe, Mayo</creatorcontrib><creatorcontrib>Onoda, Yoshito</creatorcontrib><creatorcontrib>Oyanagi, Taku</creatorcontrib><creatorcontrib>Kushimoto, Shigeki</creatorcontrib><title>Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report</title><title>Surgical Case Reports</title><addtitle>surg case rep</addtitle><description>Background
Paroxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains unelucidated. Vitamin D deficiency is a common abnormality among critically ill patients and may be associated not only with musculoskeletal complications, but also with high morbidity and mortality. The association between vitamin D deficiency and HO in patients with PSH has not yet been evaluated.
Case presentation
A 21-year-old man was in a motorcycle accident. The initial diagnosis was diffused axonal injury, thoracic aortic injury, bilateral lung contusion with hemopneumothorax, liver injury, vertebral injury of T5, along with fractures of the right humerus, left patella, bilateral scapula, and a stable pelvic fracture, with an Injury Severity Score of 50. Two weeks after admission, he was diagnosed with PSH. One month after the injury, decreased joint mobility and progressive pain were evident. Computed tomography (CT) showed HO in his humerus, ulna, radius, scapula, ilium, pubis, ischium, knee joint, patella, and tibia, as well as renal calculus. To evaluate metabolic bone abnormalities, we measured levels of 25-OH vitamin D, parathyroid hormone, calcitonin, procollagen type I N-terminal propeptide (a marker of bone formation), and tartrate-resistant acid phosphatase 5b (a marker of bone resorption). This revealed a vitamin D deficiency. Bisphosphonate agents and vitamin D were administered for 1 month. Thereafter, his symptoms, radiographic findings, and laboratory abnormalities improved, and he was transferred to another facility.
Conclusions
HO in patients with PSH, following severe head injury, may be associated with vitamin D deficiency. Medication for vitamin-D-related metabolism abnormalities may represent a novel intervention for HO with PSH.</description><subject>Alfacalcidol</subject><subject>Brain</subject><subject>Calcifediol</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Injuries</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Phosphatases</subject><subject>Physiological aspects</subject><subject>Surgery</subject><subject>Vitamin D</subject><subject>Vitamin D deficiency</subject><subject>Vitamin deficiency</subject><issn>2198-7793</issn><issn>2198-7793</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9Ustu1TAQjRCIVqU_wMoSGzYpfiRxzAKpKpQiVWIDa8vXGd_ryomD7bTkZ_jWTknFa4G88Ng-jxnPVNVLRs8Y67s3uaFS8ZpyWlNGBaubJ9UxZ6qvpVTi6R_xUXWa8w2llLW87xV7Xh0JwXnX0u64-nEFBVIscfaWxJy989YUHyfiJ2LIjDFMhdz5csBDit_XPJpA8jri0wEKsg7rDMnY4m99WYmLIcQ7P-3JuITi5wCkJLOMhtg4zuFBHYZND_FmRJv3ZAC0RSO7vkVTazKQBHNM5UX1zJmQ4fRxP6m-Xn74cnFVX3_--Oni_Lq2jeSlHoYBgDpoeSMU7HomAQwMXaucAKfs0NDBGbpzVjqwrulBKdVI2QkJOy6dOKnebbrzshthsFhzMkHPyY8mrToar_9-mfxB7-Otll0vZKNQ4PWjQIrfFshFjz5bCMFMEJesedOJjsq-5wh99Q_0Ji5pwvIQJbE1jLU9os421N4E0H5yEX0trgFGb-OEP4b3513bMc7aViCBbwSbsI8J3K_sGdUPI6O3kdE4MvrnyOgGSWIjZQRPe0i_c_kP6x5Zv8jw</recordid><startdate>20201123</startdate><enddate>20201123</enddate><creator>Sato, Takeaki</creator><creator>Watanabe, Mayo</creator><creator>Onoda, Yoshito</creator><creator>Oyanagi, Taku</creator><creator>Kushimoto, Shigeki</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6154-2968</orcidid></search><sort><creationdate>20201123</creationdate><title>Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report</title><author>Sato, Takeaki ; Watanabe, Mayo ; Onoda, Yoshito ; Oyanagi, Taku ; Kushimoto, Shigeki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-dddee0fe52439eb817eeaed659f3ef9cd40dfa0bfc7fecf48e999477637eb27f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Alfacalcidol</topic><topic>Brain</topic><topic>Calcifediol</topic><topic>Case Report</topic><topic>Case reports</topic><topic>Injuries</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Phosphatases</topic><topic>Physiological aspects</topic><topic>Surgery</topic><topic>Vitamin D</topic><topic>Vitamin D deficiency</topic><topic>Vitamin deficiency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sato, Takeaki</creatorcontrib><creatorcontrib>Watanabe, Mayo</creatorcontrib><creatorcontrib>Onoda, Yoshito</creatorcontrib><creatorcontrib>Oyanagi, Taku</creatorcontrib><creatorcontrib>Kushimoto, Shigeki</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical Case Reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sato, Takeaki</au><au>Watanabe, Mayo</au><au>Onoda, Yoshito</au><au>Oyanagi, Taku</au><au>Kushimoto, Shigeki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report</atitle><jtitle>Surgical Case Reports</jtitle><stitle>surg case rep</stitle><date>2020-11-23</date><risdate>2020</risdate><volume>6</volume><issue>1</issue><spage>293</spage><epage>293</epage><pages>293-293</pages><artnum>293</artnum><issn>2198-7793</issn><eissn>2198-7793</eissn><abstract>Background
Paroxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains unelucidated. Vitamin D deficiency is a common abnormality among critically ill patients and may be associated not only with musculoskeletal complications, but also with high morbidity and mortality. The association between vitamin D deficiency and HO in patients with PSH has not yet been evaluated.
Case presentation
A 21-year-old man was in a motorcycle accident. The initial diagnosis was diffused axonal injury, thoracic aortic injury, bilateral lung contusion with hemopneumothorax, liver injury, vertebral injury of T5, along with fractures of the right humerus, left patella, bilateral scapula, and a stable pelvic fracture, with an Injury Severity Score of 50. Two weeks after admission, he was diagnosed with PSH. One month after the injury, decreased joint mobility and progressive pain were evident. Computed tomography (CT) showed HO in his humerus, ulna, radius, scapula, ilium, pubis, ischium, knee joint, patella, and tibia, as well as renal calculus. To evaluate metabolic bone abnormalities, we measured levels of 25-OH vitamin D, parathyroid hormone, calcitonin, procollagen type I N-terminal propeptide (a marker of bone formation), and tartrate-resistant acid phosphatase 5b (a marker of bone resorption). This revealed a vitamin D deficiency. Bisphosphonate agents and vitamin D were administered for 1 month. Thereafter, his symptoms, radiographic findings, and laboratory abnormalities improved, and he was transferred to another facility.
Conclusions
HO in patients with PSH, following severe head injury, may be associated with vitamin D deficiency. Medication for vitamin-D-related metabolism abnormalities may represent a novel intervention for HO with PSH.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33226506</pmid><doi>10.1186/s40792-020-01031-4</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-6154-2968</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Alfacalcidol Brain Calcifediol Case Report Case reports Injuries Medicine Medicine & Public Health Phosphatases Physiological aspects Surgery Vitamin D Vitamin D deficiency Vitamin deficiency |
| title | Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report |
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