RESUMEN
Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier-Rotes-Querol disease, is a systemic noninflammatory disease characterized by ossification of the entheses. DISH predominantly affects the spine. Although peripheral involvement is also often reported, it rarely affects patients' function. A 77-year-old man presented to our emergency department because of incapacitating pain and stiffness in the spine and hips. The patient had been diagnosed with biopsy-proven mycosis fungoides 3 years earlier and had been treated with oral acitretin at 25 to 50 mg daily since diagnosis. However, the patient gradually developed a severely limited range of motion in his spine and hips (left > right), significantly impairing his mobility and activities of daily living. Cervical and dorsolumbar radiographs showed extensive ossification along the anterior longitudinal ligament; this finding was compatible with DISH and had not been present in radiographs taken 3 years earlier. Pelvic radiographs showed multiple enthesophytes predominantly around the coxofemoral joints. DISH has been reported as a possible long-term adverse effect of acitretin. Despite optimal conservative treatment, the patient remained severely impaired and thus finally underwent extensive osteophyte excision and total hip replacement on the left side. His acitretin therapy was also stopped to prevent further progression of his DISH.
Asunto(s)
Acitretina , Hiperostosis Esquelética Difusa Idiopática , Acitretina/efectos adversos , Actividades Cotidianas , Anciano , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Ligamentos Longitudinales , Masculino , Columna VertebralRESUMEN
Diffuse idiopathic skeletal hyperostosis (DISH) is a common degenerative enthesopathy seen in the elderly with male preponderance. It is uncommon in patients before 50 years of age and is extremely rare in patients younger than 40 years. We report a case of 33-year-old unmarried woman who presented with inflammatory spinal pain and stiffness, limited chest expansion, decreased range of spinal motion and postural abnormalities, all of which suggested the diagnosis of ankylosing spondylitis, considering the patient's age. But, further evaluation led us to the final diagnosis of DISH with associated metabolic syndrome and polycystic ovarian syndrome (PCOS). To the best of our knowledge, our patient is the first reported case of DISH in a woman less than 40 years of age, and also the first case of DISH associated with PCOS and metabolic syndrome.
Asunto(s)
Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Síndrome Metabólico/complicaciones , Dolor/diagnóstico , Síndrome del Ovario Poliquístico/complicaciones , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática/rehabilitación , Dolor/etiología , Rango del Movimiento Articular , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/patología , Espondilitis Anquilosante/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática , Espondilitis Anquilosante/complicaciones , Dolor de la Región Lumbar/complicaciones , Dolor de la Región Lumbar/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Antígeno HLA-B27/análisis , Huesos Pélvicos/patología , Huesos Pélvicos , PelvisRESUMEN
We present the case of a 35-year-old man with thoracic back pain and stiffness, whose only medical history was cystic acne treated with repeated courses of retinoids. His thoracic spine was severely limited in range of movement and was found, on X-ray, to have unilateral hyperostosis typical of diffuse idiopathic skeletal hyperostosis (DISH)--an often asymptomatic condition rarely found in those under 50. Back stiffness in young patients with prolonged retinoid exposure should be investigated.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/efectos adversos , Hiperostosis Esquelética Difusa Idiopática/inducido químicamente , Isotretinoína/efectos adversos , Adulto , Analgésicos/uso terapéutico , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/etiología , Fármacos Dermatológicos/administración & dosificación , Diagnóstico Diferencial , Esquema de Medicación , Humanos , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Isotretinoína/administración & dosificación , Masculino , Radiografía , Vértebras Torácicas/diagnóstico por imagenRESUMEN
Diffuse idiopathic skeletal hyperostosis (DISH) is difficult to distinguish from various forms of inflammatory arthritis, including psoriatic arthritis (PsA), rheumatoid arthritis, and ankylosing spondylitis. A 67-year-old Japanese male had been treated for psoriasis vulgaris for 13 years. Numbness of his right arm and lower limbs and spinal stiffening had developed 7 years prior to his initial evaluation at our facility. He noticed pain mainly while exercising. There were symmetrical marginal syndesmophytes in the spine, from the thoracic vertebrae to the upper lumbar vertebrae, on radiological examinations. We therefore suspected DISH. Furthermore, ossifications of the posterior and anterior longitudinal ligaments were noted in the cervical spine. Laboratory examinations revealed a normal peripheral white blood cell count, serum C-reactive protein, and erythrocyte sedimentation rate, and he was negative for rheumatoid factor. We detected human leukocyte antigen B39 but not B27. All distal interphalangeal joints were swollen but without pain. X-ray imaging showed narrowing of the joint space, and the consolidation of the joint was recognized, but there was no new juxta-articular bone formation. Based on clinical and radiological findings, we concluded that he had DISH and not PsA. DISH was indicated by marked radiological features of the axial skeleton, particularly the thoracic spine, but may also have involved the peripheral joints. DISH is one of the entheseal disorders, and 10% of Japanese middle-aged and elderly men have DISH. Therefore, the differentiation of DISH from PsA is necessary in psoriasis patients with spinal involvement.
Asunto(s)
Hiperostosis Esquelética Difusa Idiopática/complicaciones , Ligamentos Longitudinales/patología , Osificación del Ligamento Longitudinal Posterior/etiología , Osificación Heterotópica/etiología , Psoriasis/complicaciones , Anciano , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/etiología , Biomarcadores/sangre , Diagnóstico Diferencial , Humanos , Hiperostosis Esquelética Difusa Idiopática/sangre , Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática/patología , Inmunosupresores/uso terapéutico , Ligamentos Longitudinales/diagnóstico por imagen , Masculino , Osificación del Ligamento Longitudinal Posterior/sangre , Osificación del Ligamento Longitudinal Posterior/diagnóstico , Osificación del Ligamento Longitudinal Posterior/diagnóstico por imagen , Osificación del Ligamento Longitudinal Posterior/tratamiento farmacológico , Osificación Heterotópica/sangre , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/tratamiento farmacológico , Osificación Heterotópica/patología , Valor Predictivo de las Pruebas , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Psoriasis/patología , RadiografíaRESUMEN
The so called Forestier-Rotes Querol's disease or diffuse idiopathic skeletal hyperostosis can affect the neck caused by osteophytos and ossification-calcification of the vertebral ligaments. The location in that region can produce dysphagia or hoarseness, among other symptoms, so that the patient can assist or be sent to ENT valoration. We are reporting a case of this pathology which was diagnosed in our hospital. Finally a bibliographic review is performed.
Asunto(s)
Vértebras Cervicales , Trastornos de Deglución/etiología , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Vértebras Cervicales/diagnóstico por imagen , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Masculino , Radiografía , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). METHODS: Two patients, who presented with dysphagia resulting from large anterior osteophytes of the C-spine, were diagnosed as having DISH. A Medline search from 1964 to present, using the terms "diffuse idiopathic skeletal hyperostosis" and "cervical spine," identified several clinical manifestations associated with DISH. RESULTS: Two groups of conditions associated with DISH were found. 1. Spontaneous complications such as: dysphagia, being the commonest, dyspnea, stridor, myelopathy associated with ossification of the posterior longitudinal ligament (OPLL) or with atlanto-axial pseudoarthrosis or subluxation. Other rare events were aspiration pneumonia, sleep apnea and thoracic outlet syndrome. 2. Provoked complications such as endoscopic and intubation difficulties and fractures of the C-spine with frequent transverse shift of the fractured segment and resultant myelopathy. CONCLUSIONS: C-spine involvement in DISH is a recognized cause of various clinical manifestations involving the pharynx, larynx and the esophagus. Prior knowledge of the existence of cervical DISH should alert the clinicians for possible complications, at times severe, during invasive procedures in the neck region and as a consequence of trauma.
Asunto(s)
Vértebras Cervicales , Trastornos de Deglución/etiología , Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Análisis Químico de la Sangre , Trastornos de Deglución/diagnóstico , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Masculino , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Trastornos de Deglución/etiología , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Vértebras Cervicales/diagnóstico por imagen , Trastornos de Deglución/diagnóstico por imagen , Dexametasona/administración & dosificación , Guías como Asunto , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The twy (tiptoe-walking-Yoshimura) mouse, established in Japan in 1978 by brother-sister mating of ICR strain mice, is a valuable mutant as a model of ossification of the posterior longitudinal ligament (OPLL). OPLL causes severe myelopathy and has been thought to be very similar to ankylosing spinal hyperostosis (ASH) and diffuse idiopathic skeletal hyperostosis (DISH). In the twy mouse, both an increase in vertebral cortical membranous bone formation and a decrease in trabecular bone mass due to accelerated bone resorption occur simultaneously. This process is attributed to an inherited autosomal recessive single gene (twy). Calcitonin's suppression of bone resorption has been well established in the past, whereas the effects of this hormone on bone formation remain to be defined. Of particular interest is the simultaneous action of calcitonin on the abnormally accelerated bone formation and resorption. Thirty twy mice and 14 ICR mice were divided into seven groups, and changes induced by calcitonin on vertebral cortical appositional rate and on trabecular bone mass were investigated histomorphometrically. Results were (1) osteoclastic activity on trabecular surface was clearly suppressed by chicken calcitonin injected subcutaneously for 4 weeks; (2) no significant difference between the lumbar vertebral periosteal bone formation of calcitonin (CA) and vehicle-administrated twy mice groups. However, on the periosteal surface of the cervical vertebrae of the 6-week-old twy mice, the abnormally accelerated bone formation was suppressed by CA administration. This was also true for the elderly twy mice, although the effect was less pronounced. In conclusion, CA suppressed the abnormally hyperactivated periosteal bone formation. Results also suggested a possible therapeutic value of CA for OPLL.
Asunto(s)
Enfermedades Óseas Metabólicas/tratamiento farmacológico , Calcitonina/uso terapéutico , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Osificación del Ligamento Longitudinal Posterior/tratamiento farmacológico , Animales , Remodelación Ósea/efectos de los fármacos , Calcitonina/farmacología , Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/patología , Modelos Animales de Enfermedad , Femenino , Fluoresceínas , Colorantes Fluorescentes , Hiperostosis Esquelética Difusa Idiopática/genética , Hiperostosis Esquelética Difusa Idiopática/patología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/efectos de los fármacos , Masculino , Ratones , Ratones Endogámicos ICR , Ratones Mutantes , Osificación del Ligamento Longitudinal Posterior/genética , Periostio/efectos de los fármacos , Periostio/patología , Radiografía , TetraciclinaRESUMEN
La hiperostosis cortical idiopática con disproteinemia o síndrome de Goldbloom (SG) es un síndrome de escasa frecuencia y de etiología desconocida. Suele comenzar después de la primera infancia como una virosis inespecífica, seguido luego por fiebre, hiperostosis y trastornos en el proteinograma. Comentamos la situación de un niño de 5 años de edad con SG que se presentó como un síndrome febril prolongado (SFP) de 9 meses de evolución y dolores óseos. Al cabo del 5º mes de evolución aparecieron induraciones calientes y profundas en las extremidades proximales de ambas tibias. Presentó hipergamaglobulinemia. Las radiografías mostraron hiperostosis cortical y la centellografía un aumento de la captación del material radionucleico en las zonas afectadas. La enfermedad se prolongó por 2 años, con una mejoría progresiva y total. Debe considerarse este diagnóstico ante todo niño con SFP y dolores óseos
Asunto(s)
Humanos , Masculino , Niño , Fiebre/etiología , Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Hipergammaglobulinemia/complicaciones , Ibuprofeno/uso terapéutico , Diagnóstico Diferencial , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática , Ibuprofeno/administración & dosificaciónRESUMEN
La hiperostosis cortical idiopática con disproteinemia o síndrome de Goldbloom (SG) es un síndrome de escasa frecuencia y de etiología desconocida. Suele comenzar después de la primera infancia como una virosis inespecífica, seguido luego por fiebre, hiperostosis y trastornos en el proteinograma. Comentamos la situación de un niño de 5 años de edad con SG que se presentó como un síndrome febril prolongado (SFP) de 9 meses de evolución y dolores óseos. Al cabo del 5º mes de evolución aparecieron induraciones calientes y profundas en las extremidades proximales de ambas tibias. Presentó hipergamaglobulinemia. Las radiografías mostraron hiperostosis cortical y la centellografía un aumento de la captación del material r
Asunto(s)
Humanos , Masculino , Niño , Ibuprofeno/uso terapéutico , Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Fiebre/etiología , Hipergammaglobulinemia/complicaciones , Ibuprofeno/administración & dosificación , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Diagnóstico DiferencialAsunto(s)
Hiperostosis Esquelética Difusa Idiopática/complicaciones , Pregnatrienos/uso terapéutico , Articulación Sacroiliaca , Humanos , Hiperostosis Esquelética Difusa Idiopática/tratamiento farmacológico , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Pregnatrienos/administración & dosificaciónRESUMEN
Dysphagia due to cervical osteophytes is not common. However, diffuse idiopathic skeletal hyperostosis (DISH) with cervical involvement which causes dysphagia is even rarer. The otolaryngologist is not generally familiar with this entity. The diagnosis can be made by plain cervical X-ray films, a barium swallowing esophagogram and or a CT scan of the neck. When doubt still exists, further extra-axial X-ray films can be helpful. Although most patients have been treated surgically, there may be a role for conservative therapy initially, as surgery in elderly DISH patients is often morbid and even fatal. A 79-year-old patient with DISH (Forestier's disease) is reported. Non-steroidal anti-inflammatory therapy was successfully implemented. DISH is compared with other disorders of the cervical spine which may cause dysphagia.