Diffuse idiopathic skeletal hyperostosis: case report and literature review

Abstract

Background: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a common disorder of unknown aetiology that is characterized by back pain and spinal stiffness. Diffuse idiopathic skeletal hyperostosis is a common disease, which is most prevalent in persons over 50 years of age. Several metabolic derangements and concomitant diseases associated with DISH include obesity, increased waist circumference, hypertension, dyslipidaemia, diabetes mellitus, hyperuricemia, metabolic syndrome and an increased risk for cardiovascular diseases. There is paucity of literature on case reports and prevalence studies in Africa especially with the increase of metabolic diseases. The condition is identified radiographically by the presence of “flowing” ossification along the anterolateral margins of at least four contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. However, DISH is not limited to the spine it may affect multiple peripheral sites independently. Extra-spinal entheseal ossifications are common and observing their isolated presence may lead to the diagnosis of DISH. Treatment should be aimed at symptomatic relief of pain and stiffness, and measures such as analgesics, NSAIDs, local applications and physiotherapy, might also prove to be useful in patients with DISH. Large-scale controlled studies are needed in order to delineate the entire spectrum of this condition. The role played by the metabolic and constitutional derangements as well as its impact on the diagnosis and treatment of DISH awaits further studies. In order to raise awareness of DISH this article tackles various aspects of DISH from symptomatology, pathophysiology to its management
Case presentation: A 55 year old obese man presented with a 12 month history of lower back pain. The pain was worse in the morning and associated with progressively worsening early morning stiffness. He had noted neck stiffness with forward stooping and some mild odynophagia to solid foods. He had no history of peripheral joint involvement, fevers, cough, bowel dysfunction or psoriasis. On examination he was noted to be obese with restricted movement both active and passive throughout the spine more marked in the neck and lower back. X-rays of the spine showed flowing mantles of ossification in the anterior longitudinal ligament extending from C2 to C6 and L1 to L4 vertebrae consistent with diagnosis of DISH.

Key words: DISH, Enthesopathy, Calcification, Metabolic syndrome