Clinical variant of ossifying myositis in pediatric practice

Abstract

Introduction. Ossifying myositis is a pathological process in muscles characterized by the formation of ossification in soft tissues. At present, the etiological factors of the disease remain not fully elucidated. The triggering factors of the disease are considered to be traumatic injuries, invasive medical manipulations against the background of genetic predisposition. Aim. Invite attention of general practitioners and pediatricians to a rare disease, namely progressive ossifying fibrodysplasia in children and the peculiarities of its diagnosis. Results. The article presents a clinical case of progressive ossifying fibrodysplasia (Munchmeyer's disease) in a 4-year-old girl. At birth, the child was diagnosed with a foot deformity characteristic of this pathology (shortening of the first metatarsal finger, flexion-rotation contracture of both feet). The clinic of the disease manifested itself at the age of 3 years, when, after falling on the back, a dense formation was noticed in the area of the left shoulder blade. Half a year after the fall, swelling and pain appeared in the sacro-coccygeal region of the spine. The girl was consulted by an orthopedist, dermatologist, and oncologist. During the examination of the child, characteristic clinical features of progressive ossifying fibrodysplasia were revealed, namely, deformation and fixed position of the chest, tense neck muscles, sharp limitation of movements in all parts of the spine, limitation of bending in the left elbow joint, clinodactyly, valgus deformity of the big toes. During the ultrasound examination, the following changes were diagnosed: swelling of muscle tissue in the neck area, subscapular area on the left and sacrococcygeal joint; multiple hypoechoic formations of irregular shape, heterogeneous echo structure with hyperechoic inclusions with an acoustic shadow; a focal change in the muscle structure in the form of a loss of the characteristic pinnate structure of the perimysium. The diagnosis was confirmed histologically. No characteristic changes were found in clinical and biochemical studies. The girl is under supervision. No worsening of the child's condition has been recorded over the past four years.