Apport de la scintigraphie osseuse dans le diagnostic des arthrites inflammatoires rares : à propos d’un cas de syndrome de Sapho à l’hôpital général de Grand Yoff

Abstract

The SAPHO syndrome is suspected in a 47 years old Senegalese female patient with a swelling of medial quarter of the right clavicle, and a history of palmar pustulosis. The general state of health is preserved, biology shows a nonspecific inflammatory syndrome (elevated erythrocyte rate and C reactive protein level) and an absence of leukocytosis. Histopathological examination found a polymorphic inflammatory granuloma with mononuclear cells and giant cells. The standard radiographs and CT scans did not disclose any lesion while the bone scan displayed a “bull's horn” image of increased uptake on the right sterno-clavicular region suggestive of SAPHO syndrome. The frequent delay in diagnosis, usually related to ignorance of the syndrome and the fear of a bone tumour, is a major source of antibiotic abuse and/or biopsies, invasive or harmful for patients. Bone scintigraphy has a role to play in guiding the diagnosis when it discovers focal increased uptake on clavicle and sternum. May moreover, bone scintigraphy be useful to review and assess the distribution of lesions and their follow-up.