SHM Converge Scientific Abstract ePoster Gallery-Systemic Myositis Ossificans in a Patient With Cocaine Induced Rhabdomyolysis

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This case describes a 26-year-old man with no significant past medical history who was found unconscious and intubated for respiratory failure due to cocaine and fentanyl overdose. He developed severe rhabdomyolysis with marked metabolic derangements, including creatine kinase of 22,000 U/L, phosphorus of 20.4 mg/dL, potassium of 10 mmol/L, creatinine of 2.9 mg/dL, and low albumin with reported hypocalcemia.<br /><br />His ICU course was complicated by sepsis, internal jugular vein thrombosis, and acute kidney injury requiring hemodialysis. Over approximately three weeks, he received near-daily IV calcium for mild hypocalcemia. About one month after admission, he became profoundly hypercalcemic and required additional dialysis. He later developed palpable solid calcified masses in the muscles and soft tissues of the extremities.<br /><br />Imaging confirmed widespread myositis ossificans (MO): CT showed calcifications in muscles around both shoulders, lumbar paraspinal region, and both hips, while X-rays of the right wrist and forearm showed extensive soft tissue calcifications.<br /><br />MO is a self-limited ossifying process usually triggered by trauma, but non-traumatic causes such as drug abuse, infection, and neuromuscular dysfunction are rare. Systemic MO is especially uncommon. In this patient, the likely contributors were cocaine-induced rhabdomyolysis causing diffuse muscle injury, critical illness and sepsis leading to denervation injury, and aggressive calcium repletion in the setting of renal failure and hyperphosphatemia, promoting calcium deposition in damaged muscle.<br /><br />The key clinical lesson is that aggressive IV calcium treatment in patients with hyperphosphatemia, especially when hypocalcemia is mild and albumin is low, can contribute to systemic myositis ossificans. Careful correction of calcium for hypoalbuminemia and close monitoring are essential. The patient was discharged to acute rehabilitation 10 weeks after admission.

Asset Subtitle

Hong Yu Wang

Meta Tag

Author List Hong Yu Wang, Priyanka Sridhar, Shamit Patel, Violetta Laskova

Category Clinical Vignettes

Concept Myositis Ossificans

Concept Endothelial-Mesenchymal Transition

Concept Cocaine-Induced Rhabdomyolysis

Concept Hyperphosphatemia

Concept Trauma

Distinguished Non-Finalist

Presenter Organization Mount Sinai West and Morningside

Presenting Author Hong Yu Wang

Track Adult

Keywords

myositis ossificans

rhabdomyolysis

cocaine overdose

fentanyl overdose

hypercalcemia

hypocalcemia

hyperphosphatemia

acute kidney injury

hemodialysis

soft tissue calcification

Myositis Ossificans

Endothelial-Mesenchymal Transition

Cocaine-Induced Rhabdomyolysis

Hyperphosphatemia

Trauma