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Chronic ulcers, calcification and calcified fibrous tumours: phenotypic manifestations of a congenital disorder of heterotopic ossification.
Int Wound J 2007; 4(3):273-80IW

Abstract

Calcification is a rarely reported cause for chronic, cutaneous ulceration. Although dystrophic calcification occurs in chronic ulcers, idiopathic calcification and ossification leading to recurrent ulcerations is seldom reported. This report illustrates a challenging case with various non healing wounds, calcification/ossification and calcified fibrous tumours. A 56-year-old woman presented with chronic, painful wounds and calcified deposits in her feet, hands and abdomen, some dating back to childhood. The surgeries she had had for various unrelated conditions healed with hard, calcified deposits, which later ulcerated. Skeletal radiological imaging revealed multiple soft-tissue deposits, with calcification and areas of ossification, along with gross distortion of the bony architecture of her feet. All biochemical investigations were normal apart from raised serum alkaline phosphatase. The management has encompassed a combination of conservative and surgical measures (culminating in a left below-knee amputation) with varying degrees of success. Having ruled out other causes of subcutaneous calcification, three congenital disorders of heterotopic ossification fit this patient's presentation: Albright hereditary osteodystrophy (AHO), fibrodysplasia ossificans progressiva (FOP) and progressive osseous heteroplasia (POH). Although AHO and FOP are possibilities, POH is most likely. In addition to describing the diverse phenotypic manifestations of this disorder, this report discusses the diagnostic dilemmas, difficulties in optimising the management plan and issues relating to health-related quality of life in this patient.

Authors+Show Affiliations

Department of Medicine, New Cross Hospital, Wolverhampton, England, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17924883

Citation

Kupitz, Susanne, et al. "Chronic Ulcers, Calcification and Calcified Fibrous Tumours: Phenotypic Manifestations of a Congenital Disorder of Heterotopic Ossification." International Wound Journal, vol. 4, no. 3, 2007, pp. 273-80.
Kupitz S, Enoch S, Harding KG. Chronic ulcers, calcification and calcified fibrous tumours: phenotypic manifestations of a congenital disorder of heterotopic ossification. Int Wound J. 2007;4(3):273-80.
Kupitz, S., Enoch, S., & Harding, K. G. (2007). Chronic ulcers, calcification and calcified fibrous tumours: phenotypic manifestations of a congenital disorder of heterotopic ossification. International Wound Journal, 4(3), pp. 273-80.
Kupitz S, Enoch S, Harding KG. Chronic Ulcers, Calcification and Calcified Fibrous Tumours: Phenotypic Manifestations of a Congenital Disorder of Heterotopic Ossification. Int Wound J. 2007;4(3):273-80. PubMed PMID: 17924883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic ulcers, calcification and calcified fibrous tumours: phenotypic manifestations of a congenital disorder of heterotopic ossification. AU - Kupitz,Susanne, AU - Enoch,Stuart, AU - Harding,Keith G, PY - 2007/10/11/pubmed PY - 2008/1/25/medline PY - 2007/10/11/entrez SP - 273 EP - 80 JF - International wound journal JO - Int Wound J VL - 4 IS - 3 N2 - Calcification is a rarely reported cause for chronic, cutaneous ulceration. Although dystrophic calcification occurs in chronic ulcers, idiopathic calcification and ossification leading to recurrent ulcerations is seldom reported. This report illustrates a challenging case with various non healing wounds, calcification/ossification and calcified fibrous tumours. A 56-year-old woman presented with chronic, painful wounds and calcified deposits in her feet, hands and abdomen, some dating back to childhood. The surgeries she had had for various unrelated conditions healed with hard, calcified deposits, which later ulcerated. Skeletal radiological imaging revealed multiple soft-tissue deposits, with calcification and areas of ossification, along with gross distortion of the bony architecture of her feet. All biochemical investigations were normal apart from raised serum alkaline phosphatase. The management has encompassed a combination of conservative and surgical measures (culminating in a left below-knee amputation) with varying degrees of success. Having ruled out other causes of subcutaneous calcification, three congenital disorders of heterotopic ossification fit this patient's presentation: Albright hereditary osteodystrophy (AHO), fibrodysplasia ossificans progressiva (FOP) and progressive osseous heteroplasia (POH). Although AHO and FOP are possibilities, POH is most likely. In addition to describing the diverse phenotypic manifestations of this disorder, this report discusses the diagnostic dilemmas, difficulties in optimising the management plan and issues relating to health-related quality of life in this patient. SN - 1742-4801 UR - https://www.unboundmedicine.com/medline/citation/17924883/Chronic_ulcers_calcification_and_calcified_fibrous_tumours:_phenotypic_manifestations_of_a_congenital_disorder_of_heterotopic_ossification_ L2 - https://doi.org/10.1111/j.1742-481X.2007.00301.x DB - PRIME DP - Unbound Medicine ER -