Abstract
A 61-year-old man with myotonic dystrophy (dystrophia myotonica [DM]) complained of dysphagia. Videofluoroscopy suggested impairment of swallowing attributable to weakness of the oropharyngoesophageal muscles. To manage this problem, percutaneous endoscopic gastrostomy was attempted, but the endoscopy showed the upper esophagus was obstructed. Computed tomography (CT) of the neck showed ossification of the anterior longitudinal ligament (OALL) compressing the esophagus. In the serum, 1,25-dihydroxycholecalciferol was elevated; head CT suggested hyperostosis of the calvarium; and dual-energy X-ray absorptiometry at lumbar segments yielded a bone mineral density of 1.092 g/cm2, corresponding to 113% of the age-matched, Asian male controls. Systemic abnormal calcium metabolism could underlie this patient, which might have, directly or indirectly, contributed to OALL, resulting in dysphagia. The issue of abnormal calcium metabolism in DM deserves further exploration, as it can manifest with diverse, unexpected clinical symptoms, such as dysphagia as a result of OALL, as in the present case.
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