Fatal complication of diffuse idiopathic skeletal hyperostosis (DISH): report of a case

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory ossification involving at least four contagious vertebral bodies. It is mostly asymptomatic but the osteophytes can be rarely associated with severe complications. We report 65-year-old man who was admitted to the emergency department with severe shortness of breath and stridor not responding to medical treatment, which ended with tracheostomy lifesaving. Patient condition began 1 year ago as cervical spine pain with radiculopathy to the upper limbs, which increased to recurrent attacks of shortness of breath that responds to bronchodilators. During last months, this attack begins poorly and responds to medications and O2. Several radiological examination including x-ray, CT scan, and MRI reveal bony mass in front of the cervical spine with hypertrophy of soft tissues bulging and compressed larynx. Invasive techniques such as laryngoscope done by otolaryngologist to take biopsy from soft tissue, which reveals normal examination. In one-day, severe attack was not responding to O2 and medications ended with tracheostomy to save life. It is advisable to take in consideration that patients with DISH mostly in cervical spines may be at risk of fatal complications including airway obstruction.
Keywords DISH, shortness of breath, tracheostomy