Skip to main content
Top
Published in: BMC Medical Genetics 1/2018

Open Access 01-12-2018 | Case report

Difficult diagnosis and genetic analysis of fibrodysplasia ossificans progressiva: a case report

Authors: Shengjie Tian, Jianhua Zhu, Yaogang Lu

Published in: BMC Medical Genetics | Issue 1/2018

Login to get access

Abstract

Background

Fibrodysplasia ossificans progressiva (FOP), an ultra-rare and disabling genetic disorder of skeletal malformations and progressive heterotopic ossification, is caused by heterozygous activating mutations in activin A receptor, type I/activin-like kinase 2 (ACVR1/ALK2). The rarity of the disease makes it common to make a misdiagnosis and cause mismanagement.

Case presentation

We reported a case of a sixteen-year-old male patient who had suffered from pain and swelling in the biopsy site for two months. His physical examination presented serious stiffness and multiple bony masses in the body, with his bilateral halluces characterized by hallux valgus deformity and macrodactyly. Imaging examinations showed widespread heterotopic ossification. All laboratory blood tests were normal except for the one on alkaline phosphatase. A de novo heterozygous mutation (c.617G > A; p.R206H) were found in the ACVR1/ALK2 using gene sequencing.

Conclusion

Even though FOP is a rare disorder of genetic origin, which is generally misdiagnosed, the genetic analysis could provide definitive confirmation of the disease. Awareness of such an important approach can help clinicians to avoid the commonly practiced misdiagnosis and mismanagement of the rare disease.
Literature
1.
go back to reference Kaplan FS, Le Merrer M, Glaser DL, Pignolo RJ, Goldsby RE, Kitterman JA, Groppe J, Shore EM. Fibrodysplasia ossificans progressiva. Best Pract Res Clin Rheumatol. 2008;22(1):191–205.CrossRefPubMedPubMedCentral Kaplan FS, Le Merrer M, Glaser DL, Pignolo RJ, Goldsby RE, Kitterman JA, Groppe J, Shore EM. Fibrodysplasia ossificans progressiva. Best Pract Res Clin Rheumatol. 2008;22(1):191–205.CrossRefPubMedPubMedCentral
2.
go back to reference Schroeder HW Jr, Zasloff M. The hand and foot malformations in fibrodysplasia ossificans progressiva. Johns Hopkins Med J. 1980;147(2):73–8.PubMed Schroeder HW Jr, Zasloff M. The hand and foot malformations in fibrodysplasia ossificans progressiva. Johns Hopkins Med J. 1980;147(2):73–8.PubMed
3.
go back to reference Smith R, Athanasou NA, Vipond SE. Fibrodysplasia (myositis) ossificans progressiva: clinicopathological features and natural history. QJM. 1996;89(6):445–6.CrossRefPubMed Smith R, Athanasou NA, Vipond SE. Fibrodysplasia (myositis) ossificans progressiva: clinicopathological features and natural history. QJM. 1996;89(6):445–6.CrossRefPubMed
4.
go back to reference Cohen RB, Hahn GV, Tabas JA, Peeper J, Levitz CL, Sando A, Sando N, Zasloff M, Kaplan FS. The natural history of heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. A study of forty-four patients. J Bone Joint Surg Am. 1993;75(2):215–9.CrossRefPubMed Cohen RB, Hahn GV, Tabas JA, Peeper J, Levitz CL, Sando A, Sando N, Zasloff M, Kaplan FS. The natural history of heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. A study of forty-four patients. J Bone Joint Surg Am. 1993;75(2):215–9.CrossRefPubMed
5.
go back to reference Zhang W, Zhang K, Song L, Pang J, Ma H, Shore EM, Kaplan FS, Wang P. The phenotype and genotype of fibrodysplasia ossificans progressiva in China: a report of 72 cases. Bone. 2013;57(2):386–91.CrossRefPubMedPubMedCentral Zhang W, Zhang K, Song L, Pang J, Ma H, Shore EM, Kaplan FS, Wang P. The phenotype and genotype of fibrodysplasia ossificans progressiva in China: a report of 72 cases. Bone. 2013;57(2):386–91.CrossRefPubMedPubMedCentral
6.
go back to reference Pignolo RJ, Bedford-Gay C, Liljesthrom M, Durbin-Johnson BP, Shore EM, Rocke DM, Kaplan FS. The natural history of flare-ups in fibrodysplasia ossificans progressiva (FOP): a comprehensive global assessment. J Bone Miner Res. 2016;31(3):650–6.CrossRefPubMed Pignolo RJ, Bedford-Gay C, Liljesthrom M, Durbin-Johnson BP, Shore EM, Rocke DM, Kaplan FS. The natural history of flare-ups in fibrodysplasia ossificans progressiva (FOP): a comprehensive global assessment. J Bone Miner Res. 2016;31(3):650–6.CrossRefPubMed
7.
go back to reference Kaplan FS, Zasloff MA, Kitterman JA, Shore EM, Hong CC, Rocke DM. Early mortality and cardiorespiratory failure in patients with fibrodysplasia ossificans progressiva. J Bone Joint Surg Am. 2010;92(3):686–91.CrossRefPubMedPubMedCentral Kaplan FS, Zasloff MA, Kitterman JA, Shore EM, Hong CC, Rocke DM. Early mortality and cardiorespiratory failure in patients with fibrodysplasia ossificans progressiva. J Bone Joint Surg Am. 2010;92(3):686–91.CrossRefPubMedPubMedCentral
8.
go back to reference Kitterman JA, Kantanie S, Rocke DM, Kaplan FS. Iatrogenic harm caused by diagnostic errors in fibrodysplasia ossificans progressiva. Pediatrics. 2005;116(5):e654–61.CrossRefPubMed Kitterman JA, Kantanie S, Rocke DM, Kaplan FS. Iatrogenic harm caused by diagnostic errors in fibrodysplasia ossificans progressiva. Pediatrics. 2005;116(5):e654–61.CrossRefPubMed
9.
go back to reference Kamal AF, Novriansyah R, Rahyussalim, Prabowo Y, Siregar NC. Fibrodysplasia Ossificans Progressiva: difficulty in diagnosis and management a case report and literature review. J Orthop Case Rep. 2015;5(1):26–30.PubMedPubMedCentral Kamal AF, Novriansyah R, Rahyussalim, Prabowo Y, Siregar NC. Fibrodysplasia Ossificans Progressiva: difficulty in diagnosis and management a case report and literature review. J Orthop Case Rep. 2015;5(1):26–30.PubMedPubMedCentral
10.
go back to reference Kaplan FS, Xu M, Seemann P, Connor JM, Glaser DL, Carroll L, Delai P, Fastnacht-Urban E, Forman SJ, Gillessen-Kaesbach G, et al. Classic and atypical fibrodysplasia ossificans progressiva (FOP) phenotypes are caused by mutations in the bone morphogenetic protein (BMP) type I receptor ACVR1. Hum Mutat. 2009;30(3):379–90.CrossRefPubMedPubMedCentral Kaplan FS, Xu M, Seemann P, Connor JM, Glaser DL, Carroll L, Delai P, Fastnacht-Urban E, Forman SJ, Gillessen-Kaesbach G, et al. Classic and atypical fibrodysplasia ossificans progressiva (FOP) phenotypes are caused by mutations in the bone morphogenetic protein (BMP) type I receptor ACVR1. Hum Mutat. 2009;30(3):379–90.CrossRefPubMedPubMedCentral
11.
go back to reference Barruet E, Morales BM, Lwin W, White MP, Theodoris CV, Kim H, Urrutia A, Wong SA, Srivastava D, Hsiao EC. The ACVR1 R206H mutation found in fibrodysplasia ossificans progressiva increases human induced pluripotent stem cell-derived endothelial cell formation and collagen production through BMP-mediated SMAD1/5/8 signaling. Stem Cell Res Ther. 2016;7(1):115.CrossRefPubMedPubMedCentral Barruet E, Morales BM, Lwin W, White MP, Theodoris CV, Kim H, Urrutia A, Wong SA, Srivastava D, Hsiao EC. The ACVR1 R206H mutation found in fibrodysplasia ossificans progressiva increases human induced pluripotent stem cell-derived endothelial cell formation and collagen production through BMP-mediated SMAD1/5/8 signaling. Stem Cell Res Ther. 2016;7(1):115.CrossRefPubMedPubMedCentral
12.
go back to reference Kaplan FS, Seemann P, Haupt J, Xu M, Lounev VY, Mullins M, Shore EM. Investigations of activated ACVR1/ALK2, a bone morphogenetic protein type I receptor, that causes fibrodysplasia ossificans progressiva. Methods Enzymol. 2010;484:357–73.CrossRefPubMedPubMedCentral Kaplan FS, Seemann P, Haupt J, Xu M, Lounev VY, Mullins M, Shore EM. Investigations of activated ACVR1/ALK2, a bone morphogenetic protein type I receptor, that causes fibrodysplasia ossificans progressiva. Methods Enzymol. 2010;484:357–73.CrossRefPubMedPubMedCentral
13.
go back to reference Lakkireddy M, Chilakamarri V, Ranganath P, Arora AJ, Vanaja MC. Clinical and genetic analysis of fibrodysplasia ossificans progressiva: a case report and literature review. J Clin Diagn Res. 2015;9(8):RD01–3.PubMedPubMedCentral Lakkireddy M, Chilakamarri V, Ranganath P, Arora AJ, Vanaja MC. Clinical and genetic analysis of fibrodysplasia ossificans progressiva: a case report and literature review. J Clin Diagn Res. 2015;9(8):RD01–3.PubMedPubMedCentral
15.
go back to reference Zhou Q, Meng Y, Su L, Zhao SM, Shi HP, Huang SZ. A Chinese girl with fibrodysplasia ossificans progressiva caused by a de novo mutation R206H in ACVR1 gene. Zhonghua Er Ke Za Zhi. 2008;46(3):215–9.PubMed Zhou Q, Meng Y, Su L, Zhao SM, Shi HP, Huang SZ. A Chinese girl with fibrodysplasia ossificans progressiva caused by a de novo mutation R206H in ACVR1 gene. Zhonghua Er Ke Za Zhi. 2008;46(3):215–9.PubMed
16.
go back to reference Zhang RY, Wang J, Li Q. Report of a case with multiple myositis ossificans progressiva. Zhonghua Er Ke Za Zhi. 2006;44(2):146.PubMed Zhang RY, Wang J, Li Q. Report of a case with multiple myositis ossificans progressiva. Zhonghua Er Ke Za Zhi. 2006;44(2):146.PubMed
17.
go back to reference Liu JX, Hu R, Sun Y, Jiang H. General anesthesia in fibrodysplasia ossificans progressive: a case report and clinical review. Int J Clin Exp Med. 2014;7(5):1474–9.PubMedPubMedCentral Liu JX, Hu R, Sun Y, Jiang H. General anesthesia in fibrodysplasia ossificans progressive: a case report and clinical review. Int J Clin Exp Med. 2014;7(5):1474–9.PubMedPubMedCentral
18.
go back to reference Shore EM, Xu M, Feldman GJ, Fenstermacher DA, Cho TJ, Choi IH, Connor JM, Delai P, Glaser DL, LeMerrer M, et al. A recurrent mutation in the BMP type I receptor ACVR1 causes inherited and sporadic fibrodysplasia ossificans progressiva. Nat Genet. 2006;38(5):525–7.CrossRefPubMed Shore EM, Xu M, Feldman GJ, Fenstermacher DA, Cho TJ, Choi IH, Connor JM, Delai P, Glaser DL, LeMerrer M, et al. A recurrent mutation in the BMP type I receptor ACVR1 causes inherited and sporadic fibrodysplasia ossificans progressiva. Nat Genet. 2006;38(5):525–7.CrossRefPubMed
19.
go back to reference Bouvard B, Masson C, Legrand E, Audran M. Fibrodysplasia ossificans progressiva. A case report and focus on the BMP signaling pathway. Morphologie. 2016;100(331):250–5.CrossRefPubMed Bouvard B, Masson C, Legrand E, Audran M. Fibrodysplasia ossificans progressiva. A case report and focus on the BMP signaling pathway. Morphologie. 2016;100(331):250–5.CrossRefPubMed
20.
go back to reference Pignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev. 2013;10(Suppl 2):437–48.PubMedPubMedCentral Pignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev. 2013;10(Suppl 2):437–48.PubMedPubMedCentral
21.
go back to reference Rashid U, Bari A, Maqsood A, Naz S, Ahmad TM. Fibrodysplasia Ossificans Progressiva. J Coll Physicians Surg Pak. 2016;26(2):154–5.PubMed Rashid U, Bari A, Maqsood A, Naz S, Ahmad TM. Fibrodysplasia Ossificans Progressiva. J Coll Physicians Surg Pak. 2016;26(2):154–5.PubMed
22.
go back to reference Kaplan FS, Pignolo RJ, Shore EM. From mysteries to medicines: drug development for fibrodysplasia ossificans progressive. Expert Opin Orphan Drugs. 2013;1(8):637–49.CrossRefPubMedPubMedCentral Kaplan FS, Pignolo RJ, Shore EM. From mysteries to medicines: drug development for fibrodysplasia ossificans progressive. Expert Opin Orphan Drugs. 2013;1(8):637–49.CrossRefPubMedPubMedCentral
23.
go back to reference Kaplan FS, Groppe J, Shore EM. When one skeleton is enough: approaches and strategies for the treatment of fibrodysplasia ossificans progressiva (FOP). Drug Discov Today Ther Strateg. 2008;5(4):255–62.CrossRefPubMedPubMedCentral Kaplan FS, Groppe J, Shore EM. When one skeleton is enough: approaches and strategies for the treatment of fibrodysplasia ossificans progressiva (FOP). Drug Discov Today Ther Strateg. 2008;5(4):255–62.CrossRefPubMedPubMedCentral
24.
go back to reference Yu PB, Deng DY, Lai CS, Hong CC, Cuny GD, Bouxsein ML, Hong DW, McManus PM, Katagiri T, Sachidanandan C, et al. BMP type I receptor inhibition reduces heterotopic [corrected] ossification. Nat Med. 2008;14(12):1363–9.CrossRefPubMedPubMedCentral Yu PB, Deng DY, Lai CS, Hong CC, Cuny GD, Bouxsein ML, Hong DW, McManus PM, Katagiri T, Sachidanandan C, et al. BMP type I receptor inhibition reduces heterotopic [corrected] ossification. Nat Med. 2008;14(12):1363–9.CrossRefPubMedPubMedCentral
Metadata
Title
Difficult diagnosis and genetic analysis of fibrodysplasia ossificans progressiva: a case report
Authors
Shengjie Tian
Jianhua Zhu
Yaogang Lu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medical Genetics / Issue 1/2018
Electronic ISSN: 1471-2350
DOI
https://doi.org/10.1186/s12881-018-0543-7

Other articles of this Issue 1/2018

BMC Medical Genetics 1/2018 Go to the issue