SPINAL INFECTION WITH MEDIASTINITIS SECONDARY TO ESOPHAGEAL INJURY BY A PROMINENT OSTEOPHYTE IN A PATIENT WITH DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

Abstract

　　A man in his 80s with a history of diabetes, hypertension, and angina pectoris was admitted to the hospital after he hit his face against a “fusuma” door and subsequently complained of back pain. Magnetic resonance imaging (MRI) revealed retropharyngeal hematoma with diffuse idiopathic skeletal hyperostosis (DISH) and anteriorly projecting C7-Th1 osteophytes. Several days later, the patient presented with septic shock secondary to mediastinitis. Esophagogastroduodenoscopy demonstrated an esophageal perforation adjacent to the osteophytes, which was treated conservatively. About one month later, the patient presented with sudden-onset sustained C7-Th1 spondylodiscitis, epidural abscess, and intramedullary spinal cord abscess, resulting in persistent paraplegia. DISH is typically asymptomatic ; however, esophageal injury by prominent osteophytes may occur with neck hyperextension, highlighting the possibility of complicating spinal infection in patients with mediastinitis. MRI is useful for early diagnosis and understanding the pathophysiology in such patients.