Young thoracic vertebra diffuse idiopathic skeletal hyperostosis with Scheuermann disease:A case report

BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered in younger individuals.CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d.Upon clinical examination and imaging tests,the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis.Before the operation and medical treatment,the patient had hypoesthesia of the skin below the xiphoid process.Afterward,a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied.Subsequently,the patient was given corticosteroids,neurotrophic drugs,hyperbaric oxygen and electric stimulation.As a result of the treatment,the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs.During follow-up,the patient’s skin sensation has returned to normal.CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult.This provides a valuable reference point for spine surgeons,as DISH is more commonly observed in middle-aged and elder adults.

Rapid remission of refractory synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in response to the Janus kinase inhibitor tofacitinib: A case report

BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.

A geriatric patient with diffuse idiopathic skeletal hyperostosis

The most frequent health problems seen in senility are chronic and degenerative diseases. A 75-year-old male patient with the complaints of weight loss and difficulty in swallowing was admitted to our hospital from a nursing home. Upper system fiber-optic gastrointestinal endoscopy was performed and a mass at the junction of the hypopharynx and esophagus just below recessus piriformis obstructing almost the whole of the lumen and blocking the distal passage was detected. Computed tomography revealed marked narrowing secondary to osseous hypertrophy in the air column of the hypopharynx and proximal esophagus. Diffuse idiopathic skeletal hyperostosis or Forestier’s disease is an idiopathic disease characterized by the ossification of the anterior longitudinal ligament of vertebra and some of the extraspinal ligaments. In the present case we aim to discuss an elderly patient who suffered from dysphagia and weight loss and the diagnostic stages.

Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.

Successful Treatment of Spine Fracture for Diffuse Idiopathic Skeletal Hyperostosis with Teriparatide—A Report of Two Cases

We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatment with teriparatide. There has been no previous study on teriparatide for spine fracture in DISH. This is the first report of the successful use of teriparatide to treat spine fracture in DISH without surgical intervention. Our patients were treated with teriparatide for 8-9 months after diagnosis of the fracture. Union was obtained in two cases and no adverse events were observed during treatment. Our report showed that teriparatide could be an alternative to conventional intervention in spinal fracture of DISH.

Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis： A Case Report

Diftuse idiopathic skeletal hyperostosis （DISHL also known as Forestier＇s disease, was originally reported by Forestier and Rotes-Querol in 1950. It is a common but underdiagnosed skeletal disease characterized by massive ossification of the anterior longitudinal ligament of several vertebral bodies. The most common symptom of cervical DISH is dysphagia due to mechanical compression of the esophagus. Reports of cervical myelopathy associated with DISH are rare. Here, we present a case describing a DISH patient with cervical myelopathy who was effectively treated by a carefully designed surgical procedure.

Correlation between obesity and female hyperostosis

Background Hyperostosis is a common pathological change among people more than 50 years old; it is connected with many risk factors, which are all indefinite. The aim of this study was to prospectively investigate the correlation between obesity and female hyperostosis. Methods Totally 4326 females were included in this study and their basic information including their age, stature, body weight, course of disease, symptoms, medical complications, frequency of exercise and smoking, and X-ray and bone mineral density （BMD） examination results, was carefully collected for a statistical analysis. The t test or X^2 test was used to evaluate the differences between two groups; an analysis of variance （ANOVA） was used to evaluate the differences among several groups; the relationship between hyperostosis and body mass index （BMI）, age, medical complications, exercise, average BMD was analyzed using Logistic regression. Results The incidence rate of hyperostosis in obese patients was higher than that in patients with normal weight （,0=-0.000）. Obesity was relevant to hyperostotic sites （P=0.000）, and the incidence of hyperostosis in one or several sites of the lumbar vertebrae, knee joints, and other sites was higher in obese patients than in patients with normal weight. There was also a difference in the extent of hyperostosis between these two groups. BMI had positive effects on the incidence and degree of hyperostosis, which were also relative to the sites of hyperostosis, and the BMI of patients without hyperostosis were much lower than those of the patients with hyperostosis in their lumbar vertebrae, knee joints, or multiple sites. Obesity, age, and exercise had positive effects on the incidence of hyperostosis （P=0.002, 0.000, 0.018）. Conclusions Obesity is a significant potential stimulant of hyperostosis, especially hyperostosis in knee joints and multiple sites; keeping fit might be an important way to prevent it.

Alkaline phosphatase flare with hyperostosis of bone metastases in lung adenocarcinoma treated with gefitinib

Alkaline phosphatase(ALP)flare has been reported to occur during cancer treatment as a favorable event,particularly in the presence of bone metastasis.There have been only a few reports in lung cancer and associated radiographic findings have seldom been described.The authors observed ALP flare in a female patient with lung adenocarcinoma soon after the initiation of gefitinib.Moreover,on computed tomography,metastatic lesions of the rib and thoracic spine showed marked hyperostosis,with sizes larger than the original bone structure,suggesting efficacy of gefitinib.The significance of such hyperostosis should be elucidated.

误诊为喉咽部肿物的食管型颈椎病1例

临床上食管型颈椎病较少见,部分患者表现为吞咽困难及咽部异物感,往往首诊于耳鼻咽喉科,查体可见喉咽部隆起,由于临床医师对该病认识不足,易导致误诊及漏诊,我科经治误诊为喉咽部肿物的食管型颈椎病1例,现报道如下。1临床资料患者,男,83岁,因咽部异物感10年,进行性吞咽困难2年就诊。患者诉10年前出现咽喉部异物感,

New Osteological Data on Malaria in Sardinia from Antiquity to the Modern Era

Malaria has been an important disease throughout the history, particularly in the Mediterranean. The island of Sardinia (Italy) was characterized by severe endemic malaria from antiquity until its eradication in 1950. It provides an exceptional and unique site to examine the history of the disease and its effects on human biology and ecology. Endemic malaria can cause chronic hemolytic anemias that may result in osteological signatures. This paper examines these markers, Porotic Hyperostosis (PH) and Cribra Orbitalia (CO), which are identified from skeletons uncovered in archaeological excavations in Northern Sardinia. Previous hypotheses based on historical references and genetic data suggest that the disease was absent on the island in prehistory and was imported, probably by slaves, during the Carthaginian period (6th to 3rd century BC). This article reports on the paleontological analysis of 283 skeletons excavated from seven archeological sites dating from 4700 BP to 1582 AD. Osteological remains were examined for markers CO and PH as a proxy variable for malaria. The findings support previous hypotheses about history of malaria over time.

Double Cervical Bird Beak Sign Resulting in Dysphagia

Objective: The authors report a rare case of ossification of the anterior longitudinal ligament in the cervical spine underlying dysphagia. Case Report: We report the case of a 50-year-old male presenting with difficulty swallowing and choking. CT of the cervical spine demonstrated anterior longitudinal ligament hypertrophy with osteophytes worst at C1-C2 and C6-C7, without spinal cord compression. A videofluoroscopic swallow study revealed reduced epiglottic inversion and hyolaryngeal elevation resulting in incomplete clearance from the pharynx, as well as compression of the esophagus. Subsequently, the patient underwent osteophytectomy. There were no intraoperative or postoperative complications. Two weeks after the surgery, videofluoroscopic swallow demonstrated improved function and reduced compression. Four weeks postoperatively, the patient completely regained swallowing function without pain.

Subungual exostosis of the finger in an 8-year-old girl

Introduction:Subungual exostosis(SE)is a relatively uncommon benign bone tumor that occurs in the distal phalanges of the toes or fingers.Case presentation:An 8-year-old girl presented for treatment of an acquired mass on the distal right index finger.The patient was preoperatively diagnosed with a benign bone tumor.Surgical resection of the distal right index finger mass was performed under general anesthesia,and histological examination of the resected tissue supported a diagnosis of SE of the right index finger.The surgical outcome was good,with no surgical site infection.Throughout 15 months of follow-up,the patient was asymptomatic with no recurrence.Conclusion:Surgical resection of a mass on the distal right index finger resulted in absence of recurrence during 15 months of follow-up.SE is a benign and uncommon lesion that is infrequently encountered by physicians.This infrequent occurrence may result in delays in diagnosis and treatment.Complete excision of the lesion and careful separation from underlying nail bed structures results in total resolution of the lesion,while providing the lowest risk of recurrence.