Diffuse idiopathic skeletal hyperostosis in a 33-year-old woman with PCOS and metabolic syndrome: a rare scenario

• Published in: BMJ case reports Vol. 12; no. 10; p. e223740
• Main Authors: Chitten, Jojin Jose, James, Boblee
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2019; BMJ Publishing Group
• Series: Case report
• Subjects: Acne; Adult; Alopecia; Baldness; Body mass index; Case reports; Diagnosis, Differential; Endocrinology; Female; Growth hormones; Humans; Hyperostosis, Diffuse Idiopathic Skeletal - diagnostic imaging; Hyperostosis, Diffuse Idiopathic Skeletal - drug therapy; Hyperostosis, Diffuse Idiopathic Skeletal - rehabilitation; Insulin resistance; Insulin-like growth factors; Ligaments; Metabolic syndrome; Metabolic Syndrome - complications; Pain; Pain - diagnosis; Pain - etiology; Polycystic ovary syndrome; Polycystic Ovary Syndrome - complications; Range of Motion, Articular; Rheumatology; Spine - diagnostic imaging; Spine - pathology; Spondylitis, Ankylosing - diagnosis; Testosterone; Thyroid gland; Tomography, X-Ray Computed; Treatment Outcome; Unusual Association of Diseases/Symptoms; Womens health; metabolic syndrome; PCOS; DISH; diffuse idiopathic skeletal hyperostosis; ankylosing spondylitis; polycystic ovarian syndrome
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-223740

Diffuse idiopathic skeletal hyperostosis (DISH) is a common degenerative enthesopathy seen in the elderly with male preponderance. It is uncommon in patients before 50 years of age and is extremely rare in patients younger than 40 years. We report a case of 33-year-old unmarried woman who presented with inflammatory spinal pain and stiffness, limited chest expansion, decreased range of spinal motion and postural abnormalities, all of which suggested the diagnosis of ankylosing spondylitis, considering the patient’s age. But, further evaluation led us to the final diagnosis of DISH with associated metabolic syndrome and polycystic ovarian syndrome (PCOS). To the best of our knowledge, our patient is the first reported case of DISH in a woman less than 40 years of age, and also the first case of DISH associated with PCOS and metabolic syndrome.