A variant of diffuse idiopathic skeletal hyperostosis: a case report

Area of Science:

• Rheumatology
• Radiology
• Orthopedics

Background:

• Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) can present with spinal rigidity.
• Osteoporosis can complicate radiographic interpretation of spinal conditions.

Observation:

• An elderly male patient presented with a bamboo-like spine.
• Initial radiographs were obscured by osteoporosis, leading to a misdiagnosis of ankylosing spondylosing.
• Further imaging clarified the spinal joint integrity and revealed characteristic cortical hyperostosis.

Findings:

• The patient was ultimately diagnosed with diffuse idiopathic skeletal hyperostosis (DISH).
• Key diagnostic features included intact apophyseal and sacroiliac joints, and midcervical spine cortical hyperostosis.
• DISH diagnosis was confirmed despite initial misinterpretation due to osteoporosis.

Implications:

• Highlights the importance of advanced imaging in diagnosing spinal conditions when osteoporosis is present.
• Differentiating DISH from ankylosing spondylitis is crucial for appropriate patient management.
• Emphasizes the diagnostic challenges posed by co-existing osteoporosis and spinal pathologies.