Dysphagia and hypervitaminosis A: cervical hyperostosis.
Vertebral hyperostosis typically predominates at the thoracic spine and causes only minor symptoms. Involvement of the cervical spine may cause dysphagia due to pressure on the esophagus. We report three cases of dysphagia revealing cervical hyperostosis.


METHODS
The patients were 3 men aged 54-73 years. Dysphagia was moderate in 2 patients and severe in 1 patient who had lost 4 kg over 6 months. Stiffness of the neck with mild pain was present. One patient reported a neck injury in childhood and another had a brother and father with similar symptoms. Radiographs showed exuberant anterior cervical hyperostosis. Two patients also had hyperostotic changes at the thoracic spine and pelvis. The skin and neurological evaluation were normal. Findings were normal from standard blood tests (C-reactive protein, calcium, and vitamin D). Tests were negative for the HLA-B27 antigen in all 3 patients. Serum vitamin A levels were high, ranging from 894 to 1123 microg/L (normal, 489-720). None of the patients reported taking retinoids or having unusual eating habits.


CONCLUSIONS
Dysphagia can result from anterior cervical hyperostosis. A role for hypervitaminosis A in the genesis of hyperostosis has long been suspected. In our patients, the absence of vitamin A supplementation suggests an abnormality in vitamin A metabolism.
Wendling
Daniel
D
Service de Rhumatologie, CHU Jean Minjoz, EA 3186, Universite de Franche-Comte, Boulevard Fleming, 25030 Besançon, France. dwendling@chu-besancon.fr
Hafsaoui
Chafika
C
Laurain
Jean-Marie
JM
Runge
Michel
M
Magy-Bertrand
Nadine
N
Prati
Clément
C
D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003680:Deglutition Disorders / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015576:Hyperostosis / Q000150:complications* / Q000209:etiology* / Q000503:physiopathology; D006986:Hypervitaminosis A / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014801:Vitamin A / Q000097:blood
D014801:Vitamin A