弥漫性特发性骨肥厚误诊为强直性脊柱炎一例

摘要

Diffuse idiopathic skeletal hyperostosis (DISH),commonly occurring in the elderly,is a systematic skeletal disease characterized with extensive bone hyperplasia and hypertrophy,tendon calcification or ossification.Spinal anterolateral ligament calcification is the most common manifestation.Currently,the pathogenesis of DISH remains elusive.Due to the bamboo-like spinal lesions,DISH is likely to be misdiag-nosed as ankylosing spondylitis (AS).In this paper,we reported one male case of DISH,aged 52 years.He presented with bamboo-like spinal lesions,and progressed over the course of DISH,the sacral and iliac joints were gradually involved whereas no aggressive lesions were observed.He was repeated misdiagnosed with AS and recurred after receiving AS-targeted therapy.After a panel consultation of experts from multiple disci-plines,the patient was eventually diagnosed with DISH complicated with severe osteoporosis.The symptoms of DISH were mitigated after administration of meloxicam,calcium carbonate,alfacalcidol,elcatonin and diacere-in.He remained physically stable during subsequent follow-up.%弥漫性特发性骨肥厚（DISH）是一种常见于中老年人，以广泛骨质增生肥大、肌腱钙化或骨化为特征的全身性骨骼疾病，又以脊柱前外侧韧带钙化为最常见临床表现。目前该病发病机制尚未清楚，由于此类患者的脊柱可表现为竹节样变，故容易与强直性脊柱炎（AS）混淆。该文报道1例52岁男性 DISH 患者，其有脊柱竹节样改变，随着病情进展，其骶髂关节逐渐受累但为非侵蚀性改变，曾反复被误诊为 AS，按 AS 治疗后病情仍反复。最后经多名专家会诊，根据患者的临床表现及脊柱影像学表现，明确诊断为 DISH 并重度骨质疏松，排除 AS，给予美洛昔康、碳酸钙、阿法骨化醇、依降钙素、双醋瑞因等治疗后症状有所改善，随访情况稳定。