Abstract
The present study reports a rare case of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome in an adult male. The 42-year-old man complained of skin lesions, chest pain and lumbago. Laboratory evaluations demonstrated an elevated erythrocyte sedimentation rate and increased levels of C-reactive protein. Computerized tomography, bone scintigraphy and magnetic resonance imaging revealed multiple bone lesions. A diagnosis of SAPHO syndrome was made. Non-steroidal anti-inflammatory drugs, alendronate sodium and steroids were administered, which resulted in clinical improvement. The current case study demonstrates that skin manifestation and multiple imaging modalities are important in generating a definite diagnosis of SAPHO syndrome, and that early treatment is vital for a positive outcome.
Highlights
Acne, pustulosis, hyperostosis and osteitis (SAPHO), is a rare syndrome that is mainly reported in the West and Japan [1], with few cases reported in China
The term SAPHO syndrome was first proposed by Chamot et al in 1987 [2], to describe a group of conditions that had similar osteoarticular involvement and that were frequently associated with different forms of dermatological manifestations
Studies have shown that from its onset, SAPHO syndrome is associated with an elevated erythrocyte sedimentation rate and increased C‐reactive protein values [3,4,5]
Summary
Acne, pustulosis, hyperostosis and osteitis (SAPHO), is a rare syndrome that is mainly reported in the West and Japan [1], with few cases reported in China. In the present case study, the diagnosis and management of a Chinese patient with SAPHO syndrome is described. Physical examination on admission revealed bilateral psoriasis on the palms and interdigital surfaces of the feet, and pustules on the inner surfaces of the ankles (Fig. 1). Computerized tomography (CT) scans of the sternum, sternoclavicular joints and sacroiliac joints revealed osseous erosions on the left sternoclavicular joint area, manubrium (Fig. 2) and bilateral sacroiliac joints. Magnetic resonance imaging (MRI) scans of the lumbar spine and sacroiliac joints demonstrated bone marrow edema at the levels of the T11, L3‐L5 and S1 vertebra and the bilateral ala of sacrum (Fig. 3). Anterior and posterior views of the WBS revealed intense uptake at the proximal end of the left clavicle, manubrium sterni, fifth lumbar vertebra and right sacroiliac joint (Fig. 4). A written informed consent was obtained from the patient prior to publication
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