ABSTRACT
We describe the case of a 61-year-old female patient who presented with spondylitis of the lumbar spine. Although the microbiological cultures of the bone biopsy specimens obtained during laminotomy remained negative, the patient was treated with broad-spectrum antimicrobials for 2 months. Eight months later she started to suffer from pain and tenderness in her sternum and the medial portion of her left clavicle. The findings of computed tomography and gallium-labelled isotope scan were indicative of sternoclavicular arthritis. Again, all surgically obtained biopsy specimens yielded negative results in microbiological studies. The diagnosis of the SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteomyelitis) syndrome was then made based on the clinical presentation with recurrent sterile osteitis in two characteristic locations, and the patient was started on immunosuppressive therapy. This case is a reminder that SAPHO may sometimes occur without any skin manifestations. Since this type of patient may be admitted to an orthopedic ward, it is important that orthopedic surgeons are familiar with the syndrome.
Subject(s)
Acne Vulgaris/diagnosis , Hyperostosis/diagnosis , Lumbar Vertebrae , Osteitis/diagnosis , Psoriasis/diagnosis , Spondylitis/diagnosis , Synovitis/diagnosis , Acne Vulgaris/drug therapy , Biopsy , Female , Follow-Up Studies , Humans , Hyperostosis/drug therapy , Immunosuppressive Agents/therapeutic use , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Middle Aged , Osteitis/drug therapy , Psoriasis/drug therapy , Recurrence , Spondylitis/drug therapy , Syndrome , Synovitis/drug therapy , Tomography, X-Ray ComputedABSTRACT
A female patient with Crohn's disease developed an septic osteoarticular involvement of the left clavicle and sterno- and acromioclavicular regions. Repeated surgical revisions combined with a broad-spectrum antimicrobial treatment could not prevent the progress of the disease. However, the patient started to improve after the diagnosis of the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteomyelitis) syndrome was made and the dose of her immunosuppressive therapy increased. This patient reminds of the existence of extraintestinal aseptic infections in association with inflammatory bowel disease (IBD). Moreover, it may provide further evidence on the significant association between SAPHO and IBD.
