A Case of SAPHO Syndrome That Was Introduced to a Palliative Care Unit as Multiple Bone Metastases of Unknown Primary Carcinoma

ABSTRACT

Introduction: This study reports on a case of SAPHO syndrome in a patient in the palliative care unit who had multiple bone metastases of an unknown primary carcinoma. Case A 74 year old male presented with broken eleventh thoracic and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed multiple lesions, which were thought to be bone metastases of a carcinoma, in the thoracic and lumbar spine. Attempts to identify the location of the primary lesion were unsuccessful. Therefore, the differential diagnosis was multiple bone metastases of an unknown primary carcinoma. The patient was transferred to the palliative care unit. The patient’s condition remained largely unchanged for several years; therefore, a second set of clinical examinations was conducted. Computed tomography revealed sternocostoclavicular hyperostosis, and there was symmetric uptake on bone scintigraphy. Further MRI studies revealed that the spinal lesions were comparatively reduced, leading to a diagnosis of SAPHO syndrome. Discussion: SAPHO syndrome is a rare, benign disease that presents as a variety of osteoarticular disorders with specific dermatoses. SAPHO syndrome is difficult to diagnose; therefore, it is important to consider it as a differential diagnosis in patients with bone lesions.