Diffuse Neuritis Ossificans of the Brachial Plexus: Case report and review of the literature

Abstract Background Neuritis ossificans (intraneural heterotopic ossification) is a rare disorder described as heterotopic ossification of a nerve. We describe the presentation and management of the first reported case of neuritis ossificans with diffuse brachial plexus involvement and review the literature Case Description A 35-year-old man presented to our clinic for evaluation of right upper extremity weakness without history of trauma. He had significant, debilitating pain and magnetic resonance imaging demonstrated a complex contrast-enhancing mass with significant associated edema. Positron emission tomography demonstrated an FDG avid lesion within the brachial plexus that was confirmed by biopsy to be neuritis ossificans. The patient was treated with indomethacin and had clinical and radiographic improvement. Conclusions We present the only case of diffuse, brachial plexus neuritis ossificans. Given the challenges of surgical resection in this region, we believe medical management for complex brachial plexus lesions should be considered first, unless the sequela of the disease is sufficiently prolonged or there is concern for permanent neurovascular compromise.