嚥下障害，拘束性換気障害を呈したdiffuse idiopathic skeletal hyperostosis

A Case of Diffuse Idiopathic Skeletal Hyperostosis Presenting Dysphagia and Restrictive Ventilatory Impairment

はじめに

　Diffuse idiopathic skeletal hyperostosis（DISH）は脊椎をはじめ，骨盤や四肢諸関節周辺の靱帯や腱の骨付着部に著明な骨化を認めることを特徴とし，1975年Resnickら^1）により提唱された疾患概念である。今回われわれは，嚥下障害と拘束性換気障害を呈したDISH例を経験した。本症で嚥下障害や換気障害がみられることはあまり知られていないが，その発現機序に関する新たな知見が得られたので報告する。

Abstract

　We report a 65-years-old man suffering from slowly progressive dyspnea of four years' clinical history followed by dysphagia.　His range of motion was severely restricted in the four extremities and trunk, however, neither motor weakness nor sensory disturbance was noted.　Radiographic examination showed diffuse osteophyte formation in front of whole vertebrae but no apparent change was observed in the sacroiliac joint.　These radiographic features suggested the diagnosis of diffuse idiopathic skeletal hyperostosis (DISH) in this patient.　We consider that the restrictive ventilatory impairment in the present patient was due to the decreased thoracic cage compliance caused by hyperostosis of thoracic costovertebral joints, and the prominent osteophyte formation in front of the cervical vertebrae compressing esophagus was responsible for dysphagia.