Case Report: Acne Drug Leads Patient to Retinoid Hyperostosis

Conclusion

This clinical encounter is an opportunity to differentiate spondyloarthritis from skeletal hyperostosis. Our experience highlights retinoid hyperostosis, a condition nearly identical to diffuse idiopathic skeletal hyperostosis, as a rare cause of axial pain. Although uncommon, this diagnosis is important to make, because if caught early, cessation of isotretinoin can be recommended, and musculoskeletal symptoms can potentially be reversible.¹⁰   

Rachael Stovall, MD, is a resident in the Department of Internal Medicine at Boston Medical Center. She completed her medical degree at the University of Washington.

Akira M. Murakami, MD, is an assistant professor of radiology at Boston University School of Medicine and the section head of musculoskeletal imaging at Boston Medical Center.

Maureen Dubreuil, MD, MSc, is an assistant professor of medicine in the sections of clinical epidemiology and rheumatology at Boston University Medical Center.

References

1. Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: Clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741–750.
2. Cuesta-Vargas A, Farasyn A, Gabel CP, Luciano JV. The mechanical and inflammatory low back pain (MIL) index: development and validation. BMC Musculoskelet Disord. 2014 Jan 9;15:12.
3. Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016 Jun 30;374(26):2563–2574.
4. Olivieri I, D’Angelo S, Palazzi C, et al. Diffuse idiopathic skeletal hyperostosis: Differentiation from ankylosing spondylitis. Curr Rheumatol Rep. 2009 Oct;11(5):321–328.
5. O’Shea FD, Tsui FW, Chiu B, et al. Retinol (vitamin A) and retinol-binding protein levels are decreased in ankylosing spondylitis: clinical and genetic analysis. J Rheumatol. 2007 Dec;34(12):2457–2459.
6. Conaway HH, Henning P, Lerner UH. Vitamin A metabolism, action, and role in skeletal homeostasis. Endocr Rev. 2013 Dec;34(6):766–797.
7. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009 May;1(3):162–169.
8. Pennes DR, Ellis CN, Madison KC, et al. Early skeletal hyperostoses secondary to 13-cis-retinoic acid. AJR Am J Roentgenol. 1984 May;142(5):979–983.
9. Petscavage JM, Grauke LJ, Richardson ML. Retinoic acid arthropathy: An unusual cause of elbow pain. Radiol Case Rep. 2015 Nov 6;5(3):427.
10. Pittsley RA, Yoder FW. Retinoid hyperostosis. Skeletal toxicity associated with long-term administration of 13-cis-retinoic acid for refractory ichthyosis. N Engl J Med. 1983 Apr 28;308(17):1012–1014.
11. Accutane (isotretinoin capsules). 2010 Jan; Retrieved July 11, 2018.
12. Blasiak RC, Stamey CR, Burkhart CN, Lugo-somolinos A, Morrell DS. High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol. 2013 Dec;149(12):1392–1398.