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Li Y, Hou X, Liu S, Lu S, Du M, Dong X, Liu X, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with cranial bone involvement: Case report and literature review. Int J Rheum Dis 2023; 26:2304-2309. [PMID: 37218535 DOI: 10.1111/1756-185x.14740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoimmune inflammatory disease characterized by osteoarticular and dermatological manifestations. The most common osteoarticular manifestations involve the anterior chest wall, axial skeleton, and long bones. Cranial bone involvement is less reported in SAPHO syndrome. We herein present three cases of SAPHO syndrome with cranial bone involvement, and review the previous literature on similar manifestations. It was revealed that SAPHO syndrome could lead to cranial bone involvement, which could involve the dura mater, leading to hypertrophic pachymeningitis, but the outcome is usually good. Janus kinase inhibitors may be a potential treatment option.
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Affiliation(s)
- Yuan Li
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
| | - Siyi Lu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Du
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Dong
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoping Liu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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Yazawa Y, Itabashi R. Hypertrophic Pachymeningitis Related Brain Infarction in Synovitis-Acne-Pustulosis-Hyperostosis Osteomyelitis Syndrome. J Stroke Cerebrovasc Dis 2020; 30:105522. [PMID: 33307288 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/14/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
A 50-year-old woman with a history of synovitis-acne-pustulosis-hyperostosis osteomyelitis (SAPHO) syndrome was admitted for left unilateral neglect, dysarthria, and left hemiparesis. Brain MRI showed multiple infarctions in the territory of the right middle cerebral artery and gadolinium enhancement of the thickened frontotemporal dura mater on the right side. MR angiography showed significant narrowing of the cavernous segment of the right internal carotid artery. The right internal carotid artery stenosis was thought to originate from hypertrophic pachymeningitis associated with SAPHO syndrome. This is the first report of brain infarction due to internal carotid artery stenosis caused by hypertrophic pachymeningitis associated with SAPHO syndrome.
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Affiliation(s)
- Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
| | - Ryo Itabashi
- Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, Shiwa, Iwate, 028-3695, Japan
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Oguro E, Kato Y, Takamatsu H, Narazaki M, Kumanogoh A. A case of SAPHO syndrome with the lesions limited to the skull. Rheumatol Adv Pract 2020; 4:rkaa034. [PMID: 32968707 PMCID: PMC7494080 DOI: 10.1093/rap/rkaa034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eri Oguro
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine
| | - Yasuhiro Kato
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine.,Department of Immunopathology, Immunology Frontier Research Center.,Department of Advanced Clinical and Translational Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hyota Takamatsu
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine.,Department of Immunopathology, Immunology Frontier Research Center
| | - Masashi Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine.,Department of Immunopathology, Immunology Frontier Research Center.,Department of Advanced Clinical and Translational Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine.,Department of Immunopathology, Immunology Frontier Research Center
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A rare case: sclerosing osteomyelitis of the frontal bone. Childs Nerv Syst 2019; 35:1419-1422. [PMID: 31129705 DOI: 10.1007/s00381-019-04208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/21/2018] [Indexed: 10/26/2022]
Abstract
The patient presented in this study had a form of chronic sclerosing osteomyelitis (CSO) that is rarely reported in calvarial bones and has never been reported in the frontal bone in the literature. We aimed to contribute to the literature with this case study. In this study, we report a 14-year-old girl who presented with swelling and pain in the frontal bone and underwent treatment due to CSO. The patient had no history of trauma and chronic infection. We conclude that CSO should be considered in the differential diagnosis of the patients presenting with cranial swelling whose diagnosis cannot be established based on the radiological findings.
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Shiraishi W, Hayashi S, Iwanaga Y, Murai H, Yamamoto A, Kira JI. A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome presenting with hypertrophic pachymeningitis. J Neurol Sci 2014; 349:229-31. [PMID: 25549534 DOI: 10.1016/j.jns.2014.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/04/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
A 43-year-old woman with a 3-year history of headache, fever, and swelling of the forehead, presented to our hospital. A general examination revealed palmar and plantar pustules. Blood analyses showed an elevated white blood cell count, C-reactive protein level, and erythrocyte sedimentation rate. Brain MRI revealed a partially thickened cranial bone with gadolinium enhancement, and also abnormally enhanced dura mater. Bone scintigraphy showed involvement of the cranial bone and bilateral sternoclavicular joints. Palmar skin biopsy indicated palmoplantar pustulosis. From these results, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome with associated hypertrophic pachymeningitis was diagnosed. After corticosteroid therapy and tonsillectomy, the clinical symptoms and radiological abnormalities were improved. Clinicians should be aware of SAPHO as a potential unusual cause of hypertrophic pachymeningitis.
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Affiliation(s)
- Wataru Shiraishi
- Department of Neurology, JCHO Kyushu Hospital, 8-1 kishinoura, Yahatanishi-ku, Kitakyushu City, Fukuoka 806-8501, Japan; Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shintaro Hayashi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasutaka Iwanaga
- Department of Neurology, JCHO Kyushu Hospital, 8-1 kishinoura, Yahatanishi-ku, Kitakyushu City, Fukuoka 806-8501, Japan
| | - Hiroyuki Murai
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Akifumi Yamamoto
- Department of Neurology, JCHO Kyushu Hospital, 8-1 kishinoura, Yahatanishi-ku, Kitakyushu City, Fukuoka 806-8501, Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Gharsallah I, Souissi A, Dhahri R, Boussetta N, Sayeh S, Métoui L, Ajili F, Louzir B, Othmani S. [SAPHO syndrome]. Rev Med Interne 2014; 35:595-600. [PMID: 24797142 DOI: 10.1016/j.revmed.2013.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/29/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare entity characterized by the association of heterogeneous osteoarticular and cutaneous manifestations that have for common denominator an aseptic inflammatory process. The etiopathogeny of this disease is still a matter of debate. Although it has been related to the spondylarthritis family, an infectious origin is suggested. Diagnosis is based on the presence of at least one of the three diagnostic criteria proposed by Kahn. The treatment includes NSAIDs, antibiotics, corticosteroids, methotrexate and more recently the bisphosphonates and the TNFα inhibitors.
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Affiliation(s)
- I Gharsallah
- Service de rhumatologie, hôpital militaire de Tunis, Tunis, Tunisie.
| | - A Souissi
- Service de dermatologie, hôpital militaire de Tunis, Tunis, Tunisie
| | - R Dhahri
- Service de rhumatologie, hôpital militaire de Tunis, Tunis, Tunisie
| | - N Boussetta
- Service de médecine interne, hôpital militaire de Tunis, Tunis, Tunisie
| | - S Sayeh
- Service de rhumatologie, hôpital militaire de Tunis, Tunis, Tunisie
| | - L Métoui
- Service de rhumatologie, hôpital militaire de Tunis, Tunis, Tunisie
| | - F Ajili
- Service de médecine interne, hôpital militaire de Tunis, Tunis, Tunisie
| | - B Louzir
- Service de médecine interne, hôpital militaire de Tunis, Tunis, Tunisie
| | - S Othmani
- Service de médecine interne, hôpital militaire de Tunis, Tunis, Tunisie
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Uematsu M, Tobisawa S, Nagao M, Matsubara S, Mizutani T, Shibuya M. [Headache as a manifestation of SAPHO syndrome with a lesion extending to the dura mater, parietal bone, and temporal muscle]. Rinsho Shinkeigaku 2012; 52:106-110. [PMID: 22354235 DOI: 10.5692/clinicalneurol.52.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 50-year-old woman with a history of palmoplantar pustulosis, femur osteomyelitis, and sterno-costo-clavicular hyperostosis presented with a chronic severe left temporal headache that had progressed during the previous year. Her CRP level was elevated. Cranial images showed Gadolinium-enhancement of the left temporal muscle, left parietal bone and dura mater. (99m)Tc-HMDP scintigram showed increased uptake in the left parietal bone, left sterno-costo-clavicular joint, right femoral head and intervertebral joints. Biopsy of the lesion demonstrated 1) proliferation of connective tissue in both perimysium and endomysium of the temporal muscle with mild inflammatory cell infiltration within the interstitium, 2) marked infiltration of granulocytes to the bone marrow of the parietal bone, 3) necrosis and moderate fibrosis in the interstitium with inflammatory cell infiltration in the parietal bone, and 4) moderate fibrosis and slight infiltration of inflammatory cells in the dura mater. The patient was diagnosed with a cranial lesion of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. There was a moderate response to treatment with intravenous steroid pulse therapy and subsequent methotrexate. In a case of headache accompanied by inflammatory response, palmoplantar pustulosis and joint lesions such as hyperostosis, the possibility of a rare cranial manifestation of SAPHO syndrome should be considered.
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Affiliation(s)
- Miho Uematsu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Matzaroglou C, Velissaris D, Karageorgos A, Marangos M, Panagiotopoulos E, Karanikolas M. SAPHO Syndrome Diagnosis and Treatment: Report of Five Cases and Review of the Literature. Open Orthop J 2009; 3:100-6. [PMID: 19997538 PMCID: PMC2790148 DOI: 10.2174/1874325000903010100] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 09/28/2009] [Accepted: 10/09/2009] [Indexed: 11/22/2022] Open
Abstract
Background: The term “SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) syndrome” includes a variety of musculoskeletal disorders associated with skin conditions; Osteitis is the most prominent skeletal lesion, whereas palmoplantar pustulosis and acne are the main skin lesions. Diagnosing SAPHO syndrome is difficult, because this syndrome is often confused with suppurative osteomyelitis, which has similar clinical and pathologic findings. SAPHO diagnosis is even more difficult when atypical sites are involved and there are no skin lesions. Patients and Methods: This case series presents five patients (3 women, 2 men), ages 27 to 44 years, who came to the Orthopaedic Department outpatient clinic for evaluation of pain in the humerus, clavicle, sacroiliac joints, and/or distal radius, and were diagnosed with SAPHO syndrome. Clinical and radiologic findings, treatment and outcome data, with up to 4 years of follow-up are presented. An extensive discussion of the clinical presentation, published literature, treatment options and outcome of SAPHO syndrome is also included. Results: Once the diagnosis of SAPHO syndrome was established, treatment with antibiotics (clindamycin) and non steroid anti-inflammatory drugs (lornoxicam) was remarkably effective. All patients did well and remained symptom free for up to four years, after a 3-8 month course of treatment. Interpretation: SAPHO syndrome should be included in the differential diagnosis when evaluating patients with lytic, sclerotic, or hyperostotic bone lesions and pain. Prompt SAPHO syndrome recognition, followed by appropriate therapy with antibiotics and NSAIDs can produce rapid symptom resolution, while avoiding unnecessary procedures and longterm antibiotic therapy.
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Affiliation(s)
- Ch Matzaroglou
- Department of Orthopaedic Surgery, University of Patras Medical School, Patras, Greece
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Chua SL, Angus JE, Ravenscroft J, Perkins W. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and acne fulminans: are they part of the same disease spectrum? Clin Exp Dermatol 2009; 34:e241-3. [DOI: 10.1111/j.1365-2230.2008.03111.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nasir N, Aquilina K, Ryder DQ, Marks CJ, Keohane C. Garré's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy. Br J Neurosurg 2009; 20:415-9. [PMID: 17439095 DOI: 10.1080/02688690601046819] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Garré's chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.
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Affiliation(s)
- N Nasir
- Department of Neuropathology, Cork University Hospital, Wilton, Cork, Ireland
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Lachman RS. S. TAYBI AND LACHMAN'S RADIOLOGY OF SYNDROMES, METABOLIC DISORDERS AND SKELETAL DYSPLASIAS 2007. [PMCID: PMC7315357 DOI: 10.1016/b978-0-323-01931-6.50027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Smith M, Buller A, Radford R, Laitt R, Leatherbarrow B. Ocular presentation of the SAPHO syndrome. Br J Ophthalmol 2005; 89:1069-70. [PMID: 16024872 PMCID: PMC1772766 DOI: 10.1136/bjo.2004.057430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rutten HP, van Langelaan EJ. The SAPHO syndrome--a report of 2 patients. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:590-3. [PMID: 12440506 DOI: 10.1080/000164702321022901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Huib P Rutten
- Orthopaedic Department, Rijnland Hospital, Leiderdorp, The Netherlands.
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