Abstract
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a systemic noninflammatory condition that is characterized by unknown causes. It is closely associated with various factors including sex, age, environmental influences, genetic predisposition, and fluctuations in medication. Certain diseases, including gout, metabolic disorders such as type 2 diabetes as well as populations. Paleopathological studies of ancient remains indicate that it has been identified in various archaeological populations. The studied individual was discovered from Liyarsangbon cemetery, Amlash city, Guilan province, Iran. On the base of preliminary typology, the artifacts and grave types, the site was dated to the Parthian (247 BCE–224 CE) and in a few cases to the Sassanid period (224–651 CE). The remains of an individual with a potential case of DISH disease have attracted the interest of researchers. While there are other possible diagnoses such as spondyloarthropathies, Paget's disease, metabolic diseases, and POEMS syndrome. Following osteological examinations, advanced radiological imaging methods, in addition to visual inspection, were employed to differentiate between potential diagnoses. Based on criteria, the ultimate diagnosis was determined to be either DISH or eDISH. The presence of patchy sclerotic bone lesions in the majority of the pelvic, and spine, suggesting osteoblastic metastatic tumors that may have contributed to the individual's demise.