Heterotope ossificatie na een covid-19-pneumonie

Klinische les
28-09-2020
Danique J.M. Ploegmakers, Anna M. Zielman-Blokhuis, Hanneke J.R. van Duijnhoven, Jacky W.J. de Rooy, Alexander C.H. Geurts en Jorik Nonnekes

Dames en Heren,

Een deel van de patiënten die vanwege covid-19 langdurig zijn opgenomen op de afdeling Intensive Care ontwikkelt pijn en bewegingsbeperkingen van de gewrichten. In dit artikel illustreren we aan de hand van de ziektegeschiedenis van 2 patiënten het belang van tijdige herkenning en diagnostiek van de aandoening die hieraan ten grondslag ligt.

Heterotopic ossifications after COVID-19 pneumonia

COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.

Conflict of interest and financial support: none declared.