SAPHO Syndrome in a Patient with Breast Cancer, Successfully Treated with Pamidronate

Abstract

We report a 39-year-old woman who was diagnosed to be invasive ductal carcinoma of left breast, T1N0M0, and received modified radical mastectomy and axillary lymph node dissection at the age of 34. She developed constant pain and swelling over right sternoclavicular joint and intermittent low back pain 3 months after the surgery, and subsequent right sacroiliac joint and left sternoclavicular pain over the next 1 year. The serial bone scans revealed additive signals over right then left sternoclavicular joint, right sacroiliac joint, and right lateral border of L5 vertebral body, which was never compatible with bony metastasis. No evidence of metastasis or infection was demonstrable elsewhere. In the third year of fluctuating bone pain, she developed painless pustules over bilateral palms and soles. Together with the established characteristic hyperostosis of right sternoclavicular joint, osteitis over lumbar vertebrae and unilateral sacroilitis of right side, the diagnosis of SAPHO syndrome was deduced. Sulfasalazine was added on to the long-term NSAIDs and analgesic therapies but was not successful. Then pamidronate disodium 90 mg intravenous injection was given. The infusion was well tolerated. Her pain relieved and mobility improved gradually within one month. Up to now, she has remained symptom free for more than 1 year. This case suggests that SAPHO syndrome may be associated with breast cancer and supports that pamidronate is very effective in treating SAPHO syndrome.