Poster 6: An Unusual Aspiration Pneumonia Secondary to Diffuse Idiopathic Skeletal Hyperostosis: A Combined Medical and Rehabilitative Approach.

Setting: Outpatient rehabilitation center. Patient: An 84-year-old man presented with an 8-month history of nonsevere dysphagia that was experienced only with solid foods in a patient with diffuse idiopathic skeletal hyperostosis (DISH) or Forestier’s disease of the cervical spine. An episode of pneumonia occurred in the third and sixth months previously and the patient had been admitted to hospital and treated with antibiotics. Case Description: The patient was treated with nonsteroidal anti-inflammatory drugs (10mg aceclofenac QID, maintained for 2wk/mo), a soft diet, and rehabilitation treatment (active exercises to strengthen the swallowing musculature and effortful swallow, exercises for coordinating swallowing and breathing, for strengthening the respiratory, airflow protection maneuvers to produce safer swallowing, improve airway protection, and pharyngeal and laryngeal function, etc). Assessment/Results: At follow-up 6, 12, 18, 24, and 30 months after starting medical and rehabilitation treatment, the patient was still able to maintain an adequate oral food intake with no signs of aspiration or clinical complications. Discussion: This is the first reported case, to our knowledge, which describes a long follow-up in the dysphagia post-DISH. The dysphagia was hypothesized to be caused by mechanical compression and inflammatory changes accompanied by fibrosis in the esophagus wall. The aspiration pneumonia probably had multifactorial etiology: dysphagia, abnormal cough reflex, colonization of the oropharynx and virulent bacteria, etc. We believe that the durable improvement in our patient dysphagia is due to the combined use of medical and rehabilitation treatment. Conclusions: This case illustrates that cervical spinal abnormalities, such as Forestier’s disease, may be potentially treatable causes of aspiration pneumonia.