AN UNUSUAL CAUSE OF DYSPHAGIA: A CASE REPORT

Document Type : Case Reports

Authors

1 Department of Medicine and Theraputics School of Medicine University of Health and Allied Sciences PMB 31, Ho, Volta Region

2 Ho Teaching Hospital PMB 31, Ho, Volta Region

Abstract

Aims: To report an unusual case of dysphagia in an elderly patient caused by an anterior cervical osteophyte, and to highlight the importance of including plain cervical radiography in the diagnostic work-up of dysphagia, particularly in low-resource settings where advanced imaging may not always be available.
Patient and Methods: We reviewed the clinical presentation, investigations, management, and outcome of a 63-year-old male who presented with a two-year history of progressive dysphagia, hoarseness of voice, significant weight loss, and recent-onset jaundice. A detailed history, physical examination, laboratory investigations, imaging studies (including plain radiographs, ultrasound, and CT scans), and response to conservative management were documented.
Results: Initial endoscopy and laryngoscopy were unremarkable. The patient’s condition worsened, progressing to dysphagia for liquids and saliva retention. Laboratory results revealed severe anemia and deranged liver function tests. Abdominal ultrasound suggested hepatomegaly. A lateral neck radiograph and CT scan showed a prominent anterior cervical osteophyte at the C5 vertebra, confirming the structural cause of dysphagia. He was managed conservatively with fluids, antibiotics for concurrent pneumonia, blood transfusion, and supportive care, leading to clinical improvement. His liver function tests improved after he discontinued the herbal medications. The patient was subsequently referred for neurosurgical evaluation for definitive management of the osteophyte.
Conclusion: Cervical osteophytes, although common in older people, rarely present with dysphagia. This case emphasizes the need to consider cervical osteophyte as a differential diagnosis of dysphagia in elderly patients. Plain cervical radiographs should be incorporated early in the diagnostic algorithm in resource-limited settings to facilitate timely detection and appropriate management.

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Footnotes. Sara Salem (lecturer in the internal medicine, gastroenterology, and hepatology unit) and Ahmed al Agrodey (Professor in the internal medicine, gastroenterology, and hepatology unit) were peer reviewers. E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil, Amany Mohammed. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). It may be used, distributed, or reproduced in other forums, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal must be cited according to accepted academic practice. Disclaimer: The authors' claims in this article are solely their own and do not necessarily represent their affiliated organizations or those of the publisher, the editors, or the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethics approval The patient was informed of the intention to publish this case, and consent was obtained. Data and materials availability: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study had no funding from any source. This work was conducted in accordance with the CARE guidelines. Authors' contributions: Francis Essilfie: Supervision of patient management, literature search, drafting of manuscript Dennis Brempong: Literature search, review of manuscript Ernest Sowada: Patient care and management, which included carrying out requested investigations and carrying out treatment plans Aba Ankomaba Folson: Overall supervision of patient management, conceptualization of the idea, and review of the manuscript All authors approved the final version of the manuscript. Acknowledgments: Not applicable.

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