Subject(s)
Abdominal Abscess/prevention & control , Antitubercular Agents/therapeutic use , Medical Errors/prevention & control , Osteomyelitis/diagnosis , Osteomyelitis/prevention & control , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/drug therapy , Abdominal Abscess/diagnosis , Abdominal Abscess/etiology , Adult , Anti-Inflammatory Agents/therapeutic use , Diagnosis, Differential , Humans , Male , Osteomyelitis/drug therapy , Secondary Prevention , Treatment Outcome , Tuberculosis, Osteoarticular/complicationsABSTRACT
The treatment of the painful osteomyelitis in patients with SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) is often a problem. A 53-year-old woman had experienced palmo-plantar pustular skin lesions for four years, and in the past two years complained about progressive breath-and movement-dependent pain of the sternum. On examination she had extensive palmoplantar pustules and a painful swelling in the area of the right sternoclavicular joint. The three-phase bone scintigraphy showed a strong focal enrichment in the right sternoclavicular joint and at the transition from the manubrium to the corpus sterni suggesting active osteo-chondritis. Initially prednisolone and ibuprofen were administered, but only the skin changes regressed. The strong sternal pain decreased only after infusion of 4 mg zoledronic acid over three days. In a follow-up examination after five months the patient was still free of pain. The bisphosphonates inhibit osteoclastic activity and lead to long-lasting improvement of osteo-articular complaints in the SAPHO syndrome.
