Journal des rapports de cas cliniques

A Case of Ankylosing Spinal Hyperostosis with Dysphagia Aggravated Because of Deterioration of Depressive Symptoms

Abstract

Shinsuke Sato, Masazumi Mizuma and Fumihito Kasai

Case report: A 73-year-old male incurred extensive third-degree burns on his abdomen. Although dysphagia had not been identified before the patient sustained burn injuries, VideoFluoroscopy (VF) performed for poor ingestion revealed severe dysphagia after skin grafting surgery and Ankylosing Spinal Hyperostosis (ASH). Although the cause of dysphagia was not identified, a Percutaneous Endoscopic Gastrostomy (PEG) tube was inserted. The patient was subsequently transferred to our hospital for rehabilitation. Direct rehabilitation for dysphagia began with jelly ingestion, and meal consistency was gradually increased. On day 50, he could completely ingest meals. However, beginning on day 70 of hospitalization, the patient began to complain of mental stress because his burns were taking too long to heal, which caused him to lose sleep at night. He was diagnosed with depression and began to choke when eating meals. VF findings again revealed aspiration after swallowing, and the patient’s state of deglutition that should have improved deteriorated again. Nutrition and fluid administration required a PEG tube to be re-introduced. After the patient’s wounds healed and his mental condition stabilized, he gradually recovered the ability to ingest food. VF findings on day 103 of hospitalization revealed an improvement compared with his previous examination, and aspiration had disappeared. Discussion: The patient’s condition improved temporarily but became aggravated with the deterioration of his depressive symptoms. Subsequently, with an improvement in his depression, dysphagia improved concomitantly. Apart from the deterioration of his depressive symptoms, we did not identify any cause that may have aggravated dysphagia in the patient. We believe that aggravation of dysphagia in the pharyngeal stage could have been caused by the deterioration of the patient’s depressive symptoms when he was barely able to swallow, such as in ASH.