PubMed · 12017613
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H Valleala, M Montonen, C Lindqvist, M F Kahn, Y T Konttinen. 2000. [The unknown SAPHO].. https://pubmed.ncbi.nlm.nih.gov/12017613/
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HISTORY AND ADMISSION FINDINGS: A 63-year-old female painter was referred for evaluation of the cause of persistent back pain, night sweat and an elevated blood sedimentation rate. Besides, she reported recurrent, probably "atopic eczema" of both hands. Clinical examination revealed midthoracic back pain but no actual skin lesions. INVESTIGATIONS: Contrast medium-enhanced magnetic resonance tomography of the spine showed an increased signal intensity of the thoracic vertebral bodies 6 - 10 and the prevertebral soft tissue in T1-weighted images with fat suppression. The finding was considered to be suspicious for malignant neoplasia. Despite performing various diagnostic tests, neither a malignant nor an infectious process of the spine could be diagnosed. DIAGNOSIS, TREATMENT AND COURSE: In-depth evaluation of history and clinical findings gave the diagnosis of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis). CONCLUSION: The intention of this case report is to demonstrate, once more, the importance of carefully taking a patient's history and fully evaluating the clinical findings.
OBJECTIVES: To find diagnostic points and to identify the origin of osteomyelitis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. METHODS: Fifty-two patients with mandibular suppurative osteomyelitis and 25 patients with mandibular osteomyelitis in SAPHO syndrome were included in the study. Radiographic patterns of the lesion, types of periosteal reaction and the presence of external bone resorption and bone enlargement were investigated in each case and compared between the two entities. RESULTS: Suppurative osteomyelitis demonstrated an osteolytic pattern and a lamellated type of periosteal reaction, whereas SAPHO syndrome revealed a mixed-pattern, solid-type periosteal reaction, external bone resorption and bone enlargement. CONCLUSIONS: Radiographic examination is suggested to be convenient and a useful diagnostic method of differentiating osteomyelitis in SAPHO syndrome from suppurative osteomyelitis. The periosteum is suspected to be the original site of osteomyelitic lesions in SAPHO syndrome.
The SAPHO syndrome was a term coined to include a variety of musculoskeletal disorders associated with skin conditions, mainly palmoplantar pustulosis and acne conglobata. It is more correctly a spectrum which includes the following: skin lesions, osteoarticular manifestations of synovitis hyperostosis and osteitis affecting particular target sites, and.a clinical course marked by relapses and remissions. The major sites of involvement are the anterior chest wall, the spine, long bones, flat bones, and large and small joints. The distribution and severity of involvement varies from the adult to the pediatric form of chronic recurrent multifocal osteomyelitis (CRMO). The diagnosis of SAPHO syndrome is not difficult when the typical osteoarticular lesions are located in characteristic target sites. The diagnosis is more difficult if atypical sites are involved and there is no skin disease.