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El Harras Y, Imrani K, Setti SES, Moatassim Billah N, Nassar I. The challenging diagnosis of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A rare case report. SAGE Open Med Case Rep 2024; 12:2050313X241259395. [PMID: 38828378 PMCID: PMC11143798 DOI: 10.1177/2050313x241259395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Considered rare, the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a distinct clinical entity, associating skin manifestations and osteoarticular symptoms. Anterior chest wall pain centered at sternoclavicular and sternocostal joints is an important and characteristic clinical finding that can lead to its diagnosis. Radiologists and clinicians must be aware of synovitis-acne-pustulosis-hyperostosis-osteitis syndrome as it can mimic some of the more common disease entities such as Paget's disease. We report the case of a 63-year-old male patient, with no significant medical history, who presented to the dermatology department, with severe palmar and plantar pustulosis associated with polyarthralgia. Computerized tomography scan showed sternoclavicular hyperostosis, in favor of SAPHO syndrome, with regression of clinical symptoms after non-steroidal anti-inflammatory drug treatment.
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Affiliation(s)
- Yahya El Harras
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Kaoutar Imrani
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Sara ES Setti
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ittimade Nassar
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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2
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Anwer Khan SE, Khattak UM, Nousherwani MD. A Case Report on the Atypical Symptoms of the Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome: Could COVID-19 Be a Cause? Cureus 2023; 15:e41498. [PMID: 37551213 PMCID: PMC10404349 DOI: 10.7759/cureus.41498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare disorder with a spectrum of manifestations and overlapping osseous and cutaneous symptoms, shares pathogenesis with various autoimmune diseases. SARS-CoV-2 has been previously linked to various autoimmune diseases like Guillain-Barré syndrome (GBS), a multi-inflammatory syndrome in children (MIS-C), or rheumatoid arthritis, but there is no existing work showing a link between SAPHO syndrome and COVID-19 yet. Here, we present a case of a middle-aged Asian male who presented with minimum swelling of his right second toe, 21 days post-COVID. After a series of investigations, namely, MRI scans, 99mTc-methylene diphosphonate three-phase bone scan, and bone biopsy, followed by a positive culture and sensitivity test of the same toe, a trial of vancomycin was given to the patient to treat bacterial osteomyelitis. This resulted in no improvement, pointing toward a misdiagnosis. A conclusion of sterile osteomyelitis of his right second and third metatarsal heads and phalanges due to SAPHO syndrome, as a possible complication of SARS-CoV-2 infection, was made. There are a number of classification systems for diagnosing this syndrome, one of which was modified by Kahn and was used in our case. Atypical presentations of rare disorders like SAPHO syndrome and their relation to SARS-CoV-2 infection are still to be fully discovered and investigated. Their prevention, timely diagnosis, and management may help in alleviating the discomfort and fear associated with the unknown for the patients.
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Affiliation(s)
- Saira E Anwer Khan
- Rheumatology, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
| | - Umaima M Khattak
- Internal Medicine, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
| | - Maira D Nousherwani
- Internal Medicine, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
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3
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Shahada OO, Kurdi AS, Aljawi AF, Khayat LI, Shahadah AO. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome Diagnosis in Adolescent and Isotretinoin as a Possible Serious Exacerbating Factor. Cureus 2022; 14:e22776. [PMID: 35371846 PMCID: PMC8971070 DOI: 10.7759/cureus.22776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/05/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare auto-inflammatory condition involving cutaneous and osteoarticular manifestations. This study presents a case where a 16-year-old male with glucose-6-phosphate dehydrogenase (G6PD) deficiency presented with severe nodulocystic acne after three weeks of isotretinoin therapy. In addition to worsening acne, the patient had bone and joint pain with movement restriction. The patient’s workup showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), bilateral symmetrical sacroiliitis on magnetic resonance imaging (MRI), and multiple bony lesions on bone scintigraphy. A diagnosis of SAPHO syndrome possibly induced by isotretinoin was made. Isotretinoin discontinuation, analgesia, topical acne medications, prednisolone, and adalimumab yielded considerable clinical improvement.
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4
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Xu T, Huang Y, Zhao Y, Wang P, Chen Y. 68Ga-DOTA-FAPI-04 PET/CT Imaging in a Case of SAPHO Syndrome. Clin Nucl Med 2022; 47:246-248. [PMID: 34560692 DOI: 10.1097/rlu.0000000000003901] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 66-year-old woman presented with anterior chest wall and knee joints pain and multiple skin lesions. 99mTc-MDP bone scintigraphy showed increased bone density in the sternal angle with abnormal bone metabolism. The patient was enrolled in a 68Ga-DOTA-FAPI-04 PET/CT tumor clinical trial, and it showed increased tracer uptake in the sternum and right knee joint. Subsequently, ultrasound of the right knee joint confirmed the existence of synovitis, and no malignant components were found in sternal biopsy. The patient's final diagnosis was synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. The case confirmed that 68Ga-DOTA-FAPI-04 imaging is helpful for evaluating the involved sites of SAPHO syndrome.
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Affiliation(s)
- Tingting Xu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, PR China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, PR China; and Academician (Expert) Workstation of Sichuan Province, PR China
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5
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Yousaf A, Muhammad S, Abdelazeem B, Alam SI, Elsyaed AM. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report. Cureus 2021; 13:e19636. [PMID: 34956762 PMCID: PMC8676056 DOI: 10.7759/cureus.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/07/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.
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Affiliation(s)
- Amman Yousaf
- Internal Medicine, McLaren Flint, Flint, USA.,Radiology, Services Institute of Medical Sciences, Lahore, PAK
| | - Shoaib Muhammad
- Department of Urology, Ghulab Devi Hospital, Al-Aleem Medical College, Lahore, PAK
| | | | | | - Ahmed Mounir Elsyaed
- Orthopaedics, Weill Cornell School of Medicine - Qatar, Doha, QAT.,Orthopaedics Surgery, Hamad Medical Corporation, Doha, QAT
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6
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Condé K, Guelngar CO, Mohamed A, Adjibaye E, Cissé FA. Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) Syndrome: Clinical and Therapeutic Aspects. Cureus 2021; 13:e18332. [PMID: 34725595 PMCID: PMC8553276 DOI: 10.7759/cureus.18332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare entity. It is frequently under-detected. We report the case of SAPHO syndrome in a 38-year-old woman, seen in consultation for pain and swelling of the anterior chest wall affecting the sternoclavicular and sternocostal joints predominantly on the right, and low back pain with an inflammatory appearance with peripheral damage, especially in the legs. We also found in our patient episodes of palmoplantar pustulosis. The diagnosis of SAPHO syndrome was retained in accordance with Kahn's diagnostic criteria, and the osteitis was confirmed by morphological examinations (CT scan, MRI, and bone scintigraphy). The patient was treated with non-steroidal anti-inflammatory drugs and methotrexate with good clinical improvement.
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Affiliation(s)
- Kaba Condé
- Department of Rheumatology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN.,Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Carlos Othon Guelngar
- Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Awada Mohamed
- Department of Rheumatology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Emmanuel Adjibaye
- Department of Infectious Diseases, Reference Hospital, N'Djamena, TCD
| | - Fodé Abass Cissé
- Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
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Ohida H, Curuk C, Prescher H, Stegemann E, Bürger T. Thoracic outlet syndrome in a patient with SAPHO syndrome - A case report. Int J Surg Case Rep 2021; 80:105710. [PMID: 33667913 PMCID: PMC7937738 DOI: 10.1016/j.ijscr.2021.105710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Thoracic outlet syndrome (TOS) includes disorders caused by compression of the neurovascular structures in the upper thoracic outlet (Roos and Owens, 1996 [1]; Bürger, 2014; Curuk, 2020 [3]). Depending on the compressed structure, it is categorized into neurological, arterial and venous TOS. SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteitis syndrome) is a rare chronic inflammatory disease of unknown etiology. With its typical involvement of sternoclavicular joint and clavicle, complication due to hyperostosis in this region, leading to thrombosis of the subclavian vein have been reported in some cases of SAPHO syndrome. Between 2015 and 2019 488 patients, suffering from neurological, vascular or combined TOS presented at our department. Depending on clinical and diagnostic results surgical therapy was performed in 175 cases via the transaxillary approach, including complete first rib and/or cervical rib resection, neurolysis of plexus brachialis, thoracic sympathectomy and vascular reconstruction if indicated (Curuk, 2020). During this period, only one single patient presented with SAPHO syndrome with thrombosis of the subclavian vein and neurovascular TOS. CASE PRESENTATION We present a 50-year-old female patient, in line with the SCARE 2020 criteria (Agha et al., 2020 [12]) suffering from extremely rare combination of neurovascular TOS and SAPHO syndrome with thrombosis of the left subclavian vein due to hyperostosis of the left clavicle. CONCLUSION Progressive bone changes associated with SAPHO syndrome can lead to narrowing of the thoracic outlet. Pharmacological therapies to avoid the progression of the hyperostosis of the costoclavicular joint and the clavicle do currently not exist. First rib resection is a therapeutic option to widen the space in the upper thoracic region. Surely, it is a rare condition and more long-term follow-up data are required.
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Affiliation(s)
- H Ohida
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany.
| | - C Curuk
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
| | - H Prescher
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
| | - E Stegemann
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Angiology and Internal Medicine, Herkulesstraße 34, 34119 Kassel, Germany
| | - Th Bürger
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
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Li C, Ye Y, Cao Y, Zhang W, Xu W, Wu N, Zhang S, Zhang W. Axial skeletal lesions and disease duration in SAPHO syndrome: A retrospective review of computed tomography findings in 81 patients. Int J Rheum Dis 2020; 23:1152-1158. [PMID: 32588963 DOI: 10.1111/1756-185x.13899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Abstract
AIMS To explore the relevance of disease duration with axial skeletal lesions in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome based on computed tomography (CT). METHODS Patients who had undergone whole-spine CT were included from a previously reported single-center cohort of SAPHO syndrome. Patients with previous treatments of bisphosphates, biological agents or surgeries were excluded. Sites of axial skeletal involvement were reviewed including the spine, sacroiliac joints, and anterior chest wall. Duration of osteoarticular involvement was defined as the interval between the onset of osteoarticular symptoms and the CT evaluation. RESULTS Eighty-one patients (54 female and 27 male) were included in the study. The mean disease duration was 26.9 ± 34.9 months. Fifty (63.0%) patients showed spinal lesions on CT. The average numbers of involved vertebral segments for corner and endplate lesions were 3.16 ± 3.51 and 0.73 ± 1.85 respectively. Sixty-eight (84.0%) patients exhibited abnormalities in the anterior chest wall. The number of involved vertebral segments showed poor correlation with disease duration for both corner lesions (r2 = 0.051, P = 0.043) and endplate lesions (r2 = 0.137, P = 0.001). Patients with costoclavicular involvement showed remarkably longer disease duration than those without (49.3 ± 47.7 months vs 18.0 ± 23.5 months, P = 0.006), while no significant difference was detected regarding other structures in the anterior chest wall. CONCLUSION Costoclavicular involvement is a hallmark of long disease duration in SAPHO syndrome. Corner and endplate lesions in the vertebrae and sacroiliac involvement may not relate to disease course.
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Affiliation(s)
- Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yuqian Ye
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Beijing, China
| | - Wenrui Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
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9
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Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare clinical entity involving musculoskeletal and dermatologic systems. Its main features are prominent inflammatory cutaneous and articular manifestations. Anterior chest wall pain, more commonly at sternoclavicular and sternocostal joints, along with palmoplantar pustulosis and acne can point to this uncommon syndrome. Here, we report a case of a 15-year-old female, who presented with swelling at the anterior chest wall, was referred for the bone scan. Bone scintigraphy and single-photon emission computed tomography (SPECT/CT) detected classical “bull-head” sign, and further physical examination, for skin lesions, confirmed the diagnosis.
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Affiliation(s)
- Nitin Gupta
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritu Verma
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ethel Shangne Belho
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
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10
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Li Y, Liu G, Zhao Y, Luo Y, Lu T. SAPHO syndrome with pathological fractures of vertebral bodies: a case report. BMC Musculoskelet Disord 2019; 20:27. [PMID: 30654792 PMCID: PMC6337767 DOI: 10.1186/s12891-019-2410-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background It’s difficult to diagnose and treat synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome due to its rare and unknown pathogenesis. There is no effective treatment for SAPHO syndrome and the consequences of empirical treatment are unpredictable. This study reports a case of a young female diagnosed as SAPHO syndrome with pathological fractures of vertebral bodies. Case presentation A 29-year-old female complained of the right sternoclavicular joint and back pain accompanied limited activities and cutaneous lesions. Laboratory assays revealed abnormal inflammatory factors. Multiple imaging studies illustrated bone lesions and pathological fractures of vertebral bodies. A diagnosis of SAPHO syndrome was made. The patient was treated with Compound Troxerutin and Poreine Cerebroside Injection, non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, corticosteroids and the thoracolumbar brace. The patient was followed up for 6 months and showed improved results. Conclusions The case supports that multiple image inspections and laboratory tests contribute to diagnose SAPHO syndrome, and combination therapies of Compound Troxerutin and Poreine Cerebroside Injection, NSAIDs, bisphosphonates, corticosteroids and the thoracolumbar brace in the treatment of SAPHO syndrome with pathological fractures of vertebral bodies are crucial to regain health.
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Affiliation(s)
- Yalong Li
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Guomin Liu
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Yian Zhao
- Department of Stomatology, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Yungang Luo
- Department of Stomatology, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China. .,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China.
| | - Tiancheng Lu
- Life Sciences College, Jilin Agricultural University, Changchun, Jilin, 130118, People's Republic of China. .,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China.
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Schaub S, Sirkis HM, Kay J. Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Rheum Dis Clin North Am 2017; 42:695-710. [PMID: 27742022 DOI: 10.1016/j.rdc.2016.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.
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Affiliation(s)
- Steven Schaub
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Hartley M Sirkis
- Division of Musculoskeletal Imaging, Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
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12
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Duan N, Chen X, Liu Y, Wang J, Wang Z. Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature. Exp Ther Med 2016; 12:2665-2670. [PMID: 27698770 DOI: 10.3892/etm.2016.3689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/28/2016] [Indexed: 11/05/2022] Open
Abstract
Synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis syndrome (SAPHO) is a rare syndrome that affects the skin, bones and joints. Diagnosis of SAPHO syndrome is established on clinical appearance and imaging features. The present case report described the imaging features of three cases of SAPHO with sternoclavicular joint arthritis but without skin manifestations using multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and bone scintigraphy. The first case was a 52-year-old male who suffered from progressive sternoclavicular arthritis for 2 years. The second case was a 62-year-old female with arthritis in the larger joints for 5 years, particularly on the right thoracic area. The third case was a 44-year-old male who exhibited a slight bulge accompanied by pain in the upper anterior chest wall for 4 years. All of them lacked cutaneous lesions. CT demonstrated sclerosis and hyperostosis with subchondral erosions in the sternocostoclavicular joints. MRI revealed bone marrow edema that was slightly hypointense on T1-weighted imaging, and hyperintense on T2-weighted imaging. Typical 'bull head' signs were observed in bone scintigraphy images. The present case study demonstrated that SAPHO syndrome should be suspected in patients with multifocal osteitis or arthritis affecting the chest wall that lack skin manifestations. Multimodal imaging modalities in combination are helpful for SAPHO diagnosis.
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Affiliation(s)
- Na Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Yongkang Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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Shim HI, Park W, Kim YJ, Jung KH, Baek JH, Lim MJ, Joo K, Kwon SR. A Case Report of SAPHO Syndrome Treated with Oral Alendronate. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.5.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hyun-Ik Shim
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Yeo Ju Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Kyong-Hee Jung
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Mie-Jin Lim
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Kowoon Joo
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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