A Case Of Sternocostoclavicular Hyperostosis: Differential Diagnosis of Sclerotic Metastasis / 대한류마티스학회지

ABSTRACT

Sternocostoclavicular hyperostosis is a chronic arthro-osteitis affecting mostly jux-tasternal structures. It is characterized clinically by painfull swelling of the upper anterior chest wall and occasionally is associated with pustulosis palmaris and plantaris. A 34-year-old female presented with upper anterior chest pain and low back pain. She was well until three months ago, then left shoulder pain and multiple pustule on both palms developed. She felt gradually exhausted in spite of symptomatic medication at drug store. Eight months before this admission she underwent an operation on the right sided breast due to a benign mass. On examination there was no evidence of conjunctivitis or aphthous oral ulcer, tenderness on left sternoclavicular joint was noted and flextion of the left hip joint was limited because of pain in the joint area. Multiple pustules were noted in the palms of both hands, but it wasn't associated with nail change. The mammographs was normal. Plain radiographs of the spine showed disc space narrowing of seventh thoracic spine and spondylolysis on fifth' lumbar vertebra. Radionuclide imaging with 99mTc-methylene diphosphonate of the bone showed multiple increased uptake on both sacroiliac joints, both first costochondra] joints, left sternoclavicular joint, and eighth thoracic vertebra. Magnetic Resonance Imaging reavealed low signal intensity in medial end of the left clavicle with joint effusion and Schmorl's node in seventh thoracic disc space. Laboratory tests were normal, except ESR 23mm/h. In this case we think that careful clinical differential diagnosis of sternocostoclavicular hyperostosis should include sclerotic metastasis.