Severe acitretin-induced diffuse idiopathic skeletal hyperostosis: a case report

Area of Science:

• Rheumatology
• Dermatology
• Pharmacology

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier-Rotes-Querol disease, is a noninflammatory condition characterized by entheseal ossification, primarily affecting the spine.
• While peripheral involvement occurs, it rarely impacts patient function significantly.

Observation:

• A 77-year-old man with a history of mycosis fungoides treated with acitretin presented with severe spinal and hip pain and stiffness.
• Radiographs revealed extensive ossification compatible with DISH, absent three years prior, and multiple enthesophytes around the hip joints.
• The patient experienced a severely limited range of motion, significantly impairing daily activities.

Findings:

• Acitretin therapy was identified as a potential cause for the rapid progression of DISH.
• Despite conservative management, the patient's condition remained severe, leading to surgical intervention including osteophyte excision and total hip replacement.

Implications:

• This case underscores the potential for acitretin to induce or exacerbate DISH, even in the absence of typical inflammatory markers.
• Discontinuation of acitretin therapy was implemented to prevent further disease progression.
• Clinicians should consider DISH as a possible adverse effect in patients on long-term acitretin therapy, particularly those presenting with spinal and hip symptoms.