Rapid Progression of Heterotopic Ossification in Severe Variant of Fibrodysplasia Ossificans Progressiva with p.Arg258Gly in ACVR1: A Case Report and Review of Clinical Phenotypes

Figure 1

Clinical features, radiological examination findings, and genetic analysis results of our patient. (a–f) Clinical features of our patient at the first visit to our hospital. Left (L); right (R). (a) General appearance. Thin eyebrows, low-set ears, hypoplastic mandible, narrow chest, and shallow umbilicus were observed. (b) Hands. Incomplete syndactyly was observed in both hands. All fingers lacked nails. (c) Feet. Incomplete syndactyly was observed in both feet. All toes lacked nails. (d) Right ear. The lower part of the ear was hypoplastic. A periauricular sinus (arrow) was observed. (e) Flare-up observed at the occipital region of her head (arrow). The hair was sparse. (f) Flare-up observed at her back (arrow). (g–l) Results of radiological examinations. Left (L); right (R). (g) Roentgenograph of the hands at 7 months of age. Agenesis of all distal phalanges, second and fourth middle phalanges, and fifth metacarpal bone, fusion of enlarged first middle metacarpal bone and proximal phalange (arrows), shortened second and fourth metacarpal bones, and proximal phalanges (closed arrowheads), and hypoplasia of the fifth middle phalanges and metacarpal bones (open arrowheads) were observed. Osteochondromas were observed in both first fingers. (h) Roentgenograph of the feet at 2 years of age. Thick first metacarpal bones (arrows) and fused left fourth and fifth metacarpal bones were observed (closed arrowheads). (i) 3D CT analysis at 7 months of age. The left sternocleidomastoid muscle was ossified (arrow). Craniosynostosis was not observed. (j–l) Head CT analysis at 6 years of age. (j) Horizontal view. The septum pellucidum was lacking. The lateral ventricle was enlarged. (k) Sagittal view. The corpus callosum was thin, and a deformed brain stem with bulging dorsal pons was observed. (l) Coronal view. Not only the lateral ventricle but also the third ventricle was enlarged. The sylvian fissure was wide. (m) Results of the genetic analysis of the patient and her parents. A heterozygous base substitution from adenine to guanine at position 772, resulting in an amino acid change from arginine to glycine at 258, was observed in the patient (arrow). This substitution was not observed in either of her parents. Forward strand (F); reverse strand (R).