Cranial osteomyelitis associated with SAPHO syndrome: An underdiagnosed cause of chronic headache

Abstract

AbstractA 50‐year‐old woman having palmoplantar pustulosis was admitted with a headache accompanied by occipital bulge. She had a history of cryptogenic cervical spondylitis which had not completely remitted despite treatment with nonsteroidal anti‐inflammatory drugs. Head magnetic resonance imaging revealed enhanced swelling in the soft tissues of the right occipital region corresponding to the bulging locus. Bone scintigraphy demonstrated increased uptake in the parieto‐occipital bone, cervical spine, and sternoclavicular joints. Considering the negative results of the culture tests, she was diagnosed with aseptic cranial osteomyelitis induced by synovitis‐acne‐pustulosis‐hyperostosis‐osteitis (SAPHO) syndrome; cervical osteitis might induce her unidentified spondylitis. This syndrome is unrecognized as a cause of secondary headache. Based on our review of previous reports and the current case, we suggest that a painful bulge, which is demonstrated as an enhanced swelling in the cephalic soft tissue, may be a diagnostic cue for SAPHO syndrome.