Title : Ipsilateral heterotopic ossification in the knee and shoulder post long COVID-19 requires prolonged rehabilitation
Abstract:
A 58 year old gentleman presented to accident and emergency at district general hospital with worsening shortness of breath and a non-productive cough over a period of five days. He was initially admitted under the medical team for suspicion of SARS-CoV-2 (COVID-19) pneumonitis. Subsequently, upon deterioration of observations and a positive COVID-19 PCR, he was taken to intensive care for invasive mechanical ventilation. He required frequent proning, inotropic support and was intubated for thirty-three days. After successful extubation, he developed myopathy with limited range of motion to his right knee and right shoulder. Plain film imaging of these limbs demonstrated novel formation of heterotopic ossification without any precipitating trauma or surgery. Current literature demonstrates limited case series portraying heterotopic ossification post COVID-19. There has been negligible evidence of heterotopic ossification in the ipsilateral knee and shoulder post prolonged immobility secondary to a critical illness. Physiotherapy and rehabilitation post intensive care can be prolonged due to formation of heterotopic ossification around joints. Prolonged hospital stays may lead to a higher risk of developing infections of the chest, urine and pressure sores. The raises the question whether a severe systemic inflammatory immune response from SARS-CoV-2 virus results in histopathological processes leading to formation of heterotopic ossification not previously seen, requiring prolonged physiotherapy.
