Diffuse idiopathic skeletal hyperostosis masquerading as asthma: case report

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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.

ABBREVIATIONS ACDF = anterior discectomy and fusion; DISH = diffuse idiopathic skeletal hyperostosis; PFT = pulmonary function testing; ROM = range of motion.

Article Information

Correspondence Howard J. Ginsberg: St. Michael’s Hospital, Toronto, ON, Canada. ginsbergh@smh.ca.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2019.2.SPINE181291.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative PFT showing an obstructive respiratory defect. Pre = pre-bronchodilator values for the patient; Ref = predicted values. Figure is available in color online only.

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    Preoperative CT scan of the cervical spine showing osteophytes and ossification consistent with DISH.

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    Postoperative PFT showing resolution of the obstructive defect. The lower limits of normal (LNN) are presented for males (M) and females (F). Figure is available in color online only.

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    Postoperative CT scan of the cervical spine showing a C6–T1 ACDF with removal of the compressing osteophyte.

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