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Erschienen in:

05.05.2023 | case report

Diffuse idiopathic skeletal hyperostosis as a cause for dysphagia in a patient with ankylosing spondylitis

verfasst von: Caroline Schwarz, Michael Schwarz, Victor Schmidbauer, Franz Kainberger, Ruxandra-Iulia Milos, Herbert Langenberger, Irina Gessl, Georg Funk, Prof. Dr. Michael Gschwantler

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 11-12/2023

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Summary

Background

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ankylosing spinal alterations which are often asymptomatic but may typically cause back pain and spinal stiffness. Presence of DISH may complicate spinal trauma and lead to unstable fractures requiring surgical intervention. Treatment options include physical activity, symptomatic treatment, local heat application, and optimization of metabolic comorbidities.

Case

A multimorbid older patient was admitted to the gastroenterological ward for the investigation of progressive dysphagia and weight loss. Gastroscopy revealed a dorsal impression of the esophagus at 25 cm from the incisor. Clinical work-up including computed tomography (CT) and magnetic resonance imaging (MRI) ruled out malignancy but showed ankylosing spondylophytes and non-recent fractures of vertebrae C5–C7, compatible with DISH of the cervicothoracic spine as a cause for the esophageal impression.
Notably, imaging diagnostics showed ankylosing spine alterations extending to the lumbar spine and both sacroiliac joints, suggestive of ankylosing spondylitis (AS). Typical imaging characteristics, a history of psoriasis, and positive HLA*B27 status supported the diagnosis of underlying AS in this patient with dysphagia as an unusual primary symptom of DISH.
Additionally, pulmonary alterations compatible with a usual interstitial pneumonia (UIP)-like pattern were seen on lung CT.

Conclusion

Overlaps among AS, DISH and pulmonary abnormalities including UIP have been described previously; however, they represent unexpected findings in this older patient. This case underlines the importance of interdisciplinary collaboration and consideration of DISH as a differential diagnosis in patients with atypical symptoms.
Literatur
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Metadaten
Titel
Diffuse idiopathic skeletal hyperostosis as a cause for dysphagia in a patient with ankylosing spondylitis
verfasst von
Caroline Schwarz
Michael Schwarz
Victor Schmidbauer
Franz Kainberger
Ruxandra-Iulia Milos
Herbert Langenberger
Irina Gessl
Georg Funk
Prof. Dr. Michael Gschwantler
Publikationsdatum
05.05.2023
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 11-12/2023
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-023-02205-4