A 52-year-old man with a 10-year history of treatment-resistant asthma presented with repeated exacerbations over the course of 10 months. His symptoms were not responsive to salbutamol or inhaled corticosteroid agents, and he developed avascular necrosis of his left hip as a result of prolonged steroid therapy. Physical examination and radiography revealed signs consistent with diffuse idiopathic skeletal hyperostosis (DISH), including a C7–T1 osteophyte causing severe tracheal compression. The patient underwent C6–T1 anterior discectomy and fusion, and the compressive osteophyte was removed, which completely resolved his “asthma.” Postoperative pulmonary function tests showed normalization of his FEV1/FVC ratio, and there was no airway reactivity on methacholine challenge. DISH is a systemic, noninflammatory condition characterized by ossification of spinal entheses, and it can present with respiratory disturbances due to airway compression by anterior cervical osteophytes. The authors present, to the best of their knowledge, the first documented case of asthma as a presentation of DISH.
ABBREVIATIONSACDF = anterior discectomy and fusion; DISH = diffuse idiopathic skeletal hyperostosis; PFT = pulmonary function testing; ROM = range of motion.
FuerdererS, Eysel-GosepathK, SchröderU, DelankKS, EyselP: Retro-pharyngeal obstruction in association with osteophytes of the cervical spine. 86:837–840, 200410.1302/0301-620X.86B6.1493315330024)| false
OlivieriID’AngeloSCutroMSPadulaAPeruzGMontaruliM: Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis. Rheumatology (Oxford)46:1709–17112007
VerlaanJJ, BoswijkPFE, de RuJA, DhertWJA, OnerFC: Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction. 11:1058–1067, 20112201523610.1016/j.spinee.2011.09.014)| false
YoshimatsuYTobinoKMaedaKKubotaKHarutaYAdachiH: Management of airway obstruction due to diffuse idiopathic skeletal hyperostosis in the cervical spine: a case report and literature review. Intern Med58:271–2762019
YoshimatsuY, TobinoK, MaedaK, KubotaK, HarutaY, AdachiH, : Management of airway obstruction due to diffuse idiopathic skeletal hyperostosis in the cervical spine: a case report and literature review. 58:271–276, 201910.2169/internalmedicine.1071-1830146564)| false