THE ACQUIRED HYPEROSTOSIS SYNDROME - A CA SE-REPORT

A 49-year old patient with a known psoriasis has been suffering from s tress-induced lower back pain since 1986. In 1992 a painful swelling o f the left clavicule was noticed. During the progress of the disease c omputer tomograms and magnetic resonance images revealed a loss in bon e structure of the 5 th lumbar vertebra. X-ray pictures and computer t omograms of the left clavicle showed an osteolysis, whereas a biopsy o f the clavicle revealed no evidence of a malignant process. A skeletal scintigram visualised increased radioactivity in the thoracic and lum bar spine as well as in both clavicles close to the sternum. Following the antiphlogistic therapy a reduction in pain sensed at the clavicle was observed. For treatment of the persistent lower back pain an orth opaedic stabilisation of the lower spine (Segment L4 to S1) was perfor med in 1994, which however did not improve the pain. A histological ex amination of the bone biopsy of the 5 th lumbar vertebra produced a no n-specific inflammatory response. Subsequently an acquired hyperostosi s syndrome was diagnosed and treatment with biphosphonates was initiat ed. The success of this therapy has not yet been finally assessed.