Abstract
RATIONALE: Axial spondyloarthritis (axSpA) and diffuse idiopathic skeletal hyperostosis (DISH) exhibit substantial overlap in clinical symptoms and imaging features, frequently resulting in diagnostic errors. This case study delves into a patient initially misdiagnosed with axSpA but later confirmed to have DISH, aiming to dissect the root causes of misdiagnosis, identify critical diagnostic criteria, and devise strategies to enhance diagnostic accuracy between these 2 conditions. PATIENT CONCERNS: The patient initially presented with chronic axial pain and stiffness, symptoms commonly associated with axSpA, leading to an initial misdiagnosis. This misdiagnosis raised concerns about the effectiveness of the prescribed treatment regimen and potential long-term implications for the patient's health. DIAGNOSES: The initial diagnosis of axSpA was based on the patient's symptoms and preliminary imaging results. However, through further in-depth investigation, including a comprehensive collection of clinical manifestations, more detailed imaging analysis, and multidisciplinary consultation, the final diagnosis was revised to DISH. INTERVENTIONS: To rectify the misdiagnosis, strategies such as a more thorough gathering of patients' symptoms and signs, rational utilization of multiple auxiliary examinations (including advanced imaging techniques and laboratory tests), and collaboration with multiple disciplines (such as rheumatology, radiology, and orthopedics) were implemented. OUTCOMES: These interventions led to the accurate diagnosis of DISH, enabling the development of an appropriate treatment plan tailored to the patient's actual condition. As a result, the patient's symptoms were better managed, and the prognosis was improved. LESSONS: This case underscores the importance of recognizing the limitations of initial diagnostic approaches, overcoming cognitive biases and fixed thinking patterns among physicians, and the value of comprehensive, multidisciplinary evaluations. It provides valuable insights for clinicians to enhance their ability to distinguish between axSpA and DISH, thereby reducing the likelihood of misdiagnosis and improving overall diagnostic and treatment quality.