Assuntos
Abscesso Abdominal/prevenção & controle , Antituberculosos/uso terapêutico , Erros Médicos/prevenção & controle , Osteomielite/diagnóstico , Osteomielite/prevenção & controle , Tuberculose Osteoarticular/diagnóstico , Tuberculose Osteoarticular/tratamento farmacológico , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino , Osteomielite/tratamento farmacológico , Prevenção Secundária , Resultado do Tratamento , Tuberculose Osteoarticular/complicaçõesRESUMO
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.