Abstract
The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) includes diseases with similar osteoarticular manifestations and skin conditions. Making this diagnosis is not always obvious, especially when the clinical presentation does not fit the typical pattern of the disease or it occurs in a particular field. We described three cases where the diagnosis was difficult. A 46 year-old woman presented with cervical pain. The cervical X-ray showed the aspect of an ivory C5 vertebra. The patient had, however, preserved general condition, no signs of underlying neoplasia, nor other joint complaints. Blood analysis was normal. Tomography did not find any suspect lesion but showed sclerosis and hyperostosis of the manubrium. Scintigraphy showed the characteristic “bullhead” appearance. A 61-year-old woman had thoracic and lumbar pain. MRI showed spondylodiscitis in D3-D4, D4-D5, D5-D6, D6-D7, and L1-L2 with paraspinal soft tissue involvement, simulating infectious spondylodiscitis. Infectious investigations and discovertebral biopsy performed twice were negative. SAPHO syndrome was then suspected. Bone scintigraphy showed uptake in the chondrosternal articulations and D4 to D7 vertebrae. The diagnosis of SAPHO was established. The third case was a 46-year-old man with a lung adenocarcinoma. Staging for metastatic disease, a TAP tomography was performed and showed osteosclerosis of D8 to D12 and intra-articular bridges in the sacroiliac joints. MRI and scintigraphy eliminated malignancy and confirmed the diagnosis of SAPHO. In our cases, imaging findings could facilitate differentiating SAPHO syndrome from other diseases.
Highlights
Introduction e acronymSAPHO includes a group of diseases with similar osteoarticular manifestations and skin conditions [1, 2]. e incidence is thought to be less than 1/10000, with the highest occurrence in children and young adults [3, 4]. ere are no validated diagnostic criteria, and the diagnosis relies on clinical and radiological findings
Given that the tumor was in remission and there was no recent worsening of the low back pain and considering the intra-articular sacroiliac bone bridges and the involvement of the anterior chest wall, the diagnosis of SAPHO syndrome was established (Figure 7)
SAPHO syndrome was first described by the French Society of Rheumatology in 1987 as a group of musculoskeletal manifestations that may or may not be associated with dermatologic lesions [1]. e osteoarticular manifestations include synovitis, hyperostosis, and osteitis. e skin manifestations are typically palmoplantar pustulosis and Arguments for (+) or against (-)
Summary
A 46 year-old woman presented with cervical pain. A 46-year-old woman presented with an eightmonth history of cervical pain. She had no personal medical history and no history of retinoid intake. As infection and neoplasia were rolled out and as our patient fulfilled Benhamou et al.’s [2] diagnostic criteria, the SAPHO syndrome diagnosis was established (Figure 2). E diagnosis of SAPHO was suspected, and bone scintigraphy was performed showing uptake in the chondrosternal articulations and D4 to D7 vertebrae, supporting the diagnosis of SAPHO (Figure 4). Given that the tumor was in remission and there was no recent worsening of the low back pain and considering the intra-articular sacroiliac bone bridges and the involvement of the anterior chest wall, the diagnosis of SAPHO syndrome was established (Figure 7). A control TAP scan was performed, showing stable spine lesions and ankylosis of the sacroiliac joint (Figure 8)
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