Diffuse idiopathic skeletal hyperostosis (DISH) associated diffuse mixed connective tissue disease – CASE REPORT

Diffuse idiopathic skeletal hyperostosis (DISH) has several synonyms, including ankylosing hyperostosis and Forestier's disease. It is a noninflammatory disease, with the principal manifestation being calcification and ossification of spinal ligaments and the regions where tendons and ligaments attach to bone (entheses). We present below the case of a male patient, aged 64 years, in treatment in our clinic for intense back pain and functional impotence back injury symptoms that started insidiously after a few months. From history we notice that the patient was diagnosed with mixed connective tissue disease, in chronic treatment with cortisone and anticoagulant, also presenting systemic vasculitis, antiphospholipid syndrome, dermatomyositis signs, thrombophilia, old stroke signs, Sjogren syndrome, Dupuytren's disease, a fracture history, osteoporosis. Discussion The concept of overlap syndromes makes many rheumatologists feel uneasy, although their distinctiveness is no longer the subject of the intense debate that it was in the past. In practice, the diagnosis of an overlap syndrome makes little difference to treatment although the detection of an autoantibody does help the clinician to anticipate particular complications.  Diffuse idiopathic skeletal hyperostosis associated is rarely cited in the literature, most clinical entities associated with mixed connective tissue disease being auto-immune and inflammatory nature. Interestingly, skeletal hyperostosis may be present at other levels, because can be disorders in connective tissue within the underlying disease and can be also a problem of differential diagnosis of ankylosing spondylitis. HIPEROSTOZA SECHELETALA DIFUZA ASOCIATA CU BOALA MIXTA DE TESUT CONJUNCTIV – PREZENTARE DE CAZ Madalina Iliescu, Sandica Albina, Mihaela Marinica, Anatoli Covaleov, Adriana Clipa, Camelia Ciobotaru, Viorel Lucescu, Dan Iliescu Clinica Grand Eforie Nord Facultatea de Medicina Constanta Hiperostoza Scheletala Difuza, cunoscuta si ca spondiloza hiperostozanta sau ca boala Forestier, este o boala neinflamatorie, care se caracterizeaza in principal prin calcificarea si osificarea ligamentelor spinale si/sau calcificarea tendoanelor si ligamentelor in zonele de insertie pe corpul vertebral (entezite). Va prezentam in continuare cazul unui pacient de sex masculin, in virsta de 64 de ani, care se prezinta in clinica noastra pentru dorsalgii intense si impotenta functionala dorso-lombara, simptomatologie care a debutat insidios, in urma cu citeva luni. Din antecedente retinem faptul ca pacientul este in evidenta cu diagnosticul de Boala Mixta de Tesut Conjunctiv, in tratament cronic cu cortizon si anticoagulant, prezentand de asemenea fenomene sistemice de vasculita, sindrom antifosfolipidic, semne de dermatomiozita, fenomene de trombofilie, fenomene sechelare unui AVC, Sindrom Sjogren, Maladie Dupuytrene. Prezinta de asemenea o fractura pertrohanteriana in antecedente, pe fondul osteoporozei secundare postcortizonice. DISCUTII Conceptul de Boala Mixta de Tesut Conjunctiv reprezinta inca o provocare pentru practician, dozarea anticorpilor specifici ajutand la anticiparea complicatiilor specifice bolii. Asocierea Hiperostozei Scheletale Difuze in evolutia afectiunii este rar citata in literatura, majoritatea entitatilor clinice asociate Bolii Mixte de Tesut Conjunctiv fiind de natura auto-imuna si inflamatorie. Interesant este faptul ca hiperostoza scheletala ar putea fii prezenta si la alte niveluri, datorita tulburarilor existente in tesutul conjunctiv in cadrul afectiunii de baza, cit si datorita perturbarii metabolice postcortizonice si poate fii o problema de diagnostic diferential cu spondilita ankilozanta.