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11/27. The "SAPHO" syndrome: a case report of a patient with unusual bone scan findings.

    PURPOSE: The authors describe the clinical and bone scintigraphic findings of the SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The case report illustrates the significance of bone scintigraphy in the diagnosis. It shows that Tc-99m MDP scanning can detect signs of arthritis not seen with other imaging methods, because the arthritis is inflammatory in nature and does not always cause bone erosion. Thus it is not visualized on plain radiographs. knowledge of this disorder may help in the differential diagnosis of arthritis. MATERIALS AND methods: Tc-99m MDP bone scintigraphy was used to diagnose arthritic changes. Whole-body and multiple delayed spot images were obtained in a 39-year-old diabetic, hypertensive woman who had tenderness in the plantar aspect of her heels. Swelling of the small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders was noted. She also had hydradenitis suppurativa and a history of a previous episode in which the arthritis improved after surgical treatment for the hydradenitis. RESULTS: All active joint lesions were visualized on the bone scan, including the arthritis, which was not detected with other imaging methods. They were all well demonstrated in the bone scintiscan. The scan findings, along with the presence of hydradenitis, led to the correct diagnosis of SAPHO syndrome. CONCLUSION: Tc-99m MDP bone scanning may be helpful in diagnosing arthritis as associated with the SAPHO syndrome.
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12/27. Scintigraphic evaluation of chronic osteomyelitis of the mandible in SAPHO syndrome.

    A patient with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) was evaluated by combined scintigraphy. (99m)Tc HMDP scintigraphy showed accumulation in the sternum and lumbar vertebrae as well as the right mandible, whereas (67)Ga citrate showed an accumulation in the right mandible, but not in the sternum or lumbar vertebrae. These results are consistent with chronic osteomyelitis in the mandible.
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13/27. SAPHO syndrome and transient hemiparesis in a child: coincidence or new association?

    We describe a case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO syndrome) in an 8-year-old boy with an unusual presentation of acute transitory hemiparesis. SAPHO syndrome has been reported in association with inflammatory bowel diseases, chest complications, and pulmonary involvement. No patient with both SAPHO syndrome and neurologic complaints has been previously described. Further observations are needed to confirm if SAPHO syndrome and hemiparesis represent a coincidence or a new association.
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14/27. Coincidence of Behcet's disease and SAPHO syndrome.

    A young woman presented with deteriorated visual acuity due to acute retinal vasculitis. The diagnosis of Behcet's disease was made on the basis of the ophthalmologic findings and recurrent oral and genital aphthous ulcerations. In the past, this young woman had been operated on several times because of progressive aseptic osteitis of the right clavicle. The actual examination revealed chronic osteitis, osteosclerosis and hyperostosis of the anterior chest wall, as well as severe acne papulopustulosa et conglobata. These findings resulted in an additional diagnosis of SAPHO syndrome. This report is the first description of Behcet's disease occurring in association with SAPHO syndrome, both fulfilling the diagnostic criteria.
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15/27. Stress in a case of SAPHO syndrome.

    In this article, we describe a case of seemingly stress-induced SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome in a man who exhibited the central features of palmoplantar psoriasis and anterior chest involvement. We also review the etiology, pathogenesis, and treatment of SAPHO syndrome and emphasize the important differences between this syndrome and psoriatic arthritis.
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16/27. Bone scintigraphy using Tc-99m DPD and F18-FDG in a patient with SAPHO syndrome.

    synovitis (inflammatory arthritis), acne (pustulosa), palmoplantar pustulosis, hyperostosis and osteitis (bland osteomyelitis) are symptoms forming the acronym SAPHO. We present the case of a 48-year old man with sterno-costo-clavicular hyperostosis and typical pustulosis palmaris. We performed Tc-99m DPD serial bone scanning to monitor the course of disease and to assess therapeutic efficiency. Control bone scans in 2001 showed minor compromises of the ribs and diminished disease activity on collarbones and the sternum after medication with non-steroidal anti-inflammatory drugs (NSAIDs) and bisphosphonates. F-18 FDG PET presented synovial inflammation in the left sterno-clavicular joint but no relevant tracer uptake on clavicles or breastbones. In case of diagnostic doubts F-18 FDG PET could be recommended in order to discriminate bland osteomyelitis from bacterial osteomyelitis or from bone malignancy when SAPHO-syndrome is assumed.
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17/27. SAPHO syndrome presenting as septic arthritis in the hip.

    We report the case of a young female presenting to our care with right hip pain. Initially treated as a septic arthritis, there was no response to antibiotic treatment. Further clinical and radiological investigation showed signs of SAPHO syndrome. This is a syndrome characterised by the variable presentation of synovitis, acne, pustulosis, hyperostosis and osteitis. The patient subsequently settled on conservative management and made a full recovery.
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18/27. hyperostosis and osteitis in Sapho syndrome: conservative or surgical treatment.

    Sapho syndrome is characterized by synovitis, acne, pustulosis, hyperostosis and osteitis. It is a rare disease, with a benign prognosis; at the osteoarticular level it is painful and is characterized by episodes of arthritis of an intermittent and at times disabling nature. The etiopathogenesis of Sapho syndrome is still not clearly defined: some authors suggest a probable correlation with an infective agent, others instead include Sapho among seronegative spondylites. The treatment of symptomatic skeletal injuries (hyperostosis, osteitis) is controversial and not classified. In the rare cases reported in the literature surgical treatment has not proven to be more effective than conservative treatment. The authors report the poor evolution of the disease in a patient affected with Sapho syndrome who came to our observation after being submitted to medullary decompression of the femoral diaphysis because of the presence of metaphyseal hyperostosis of the left femur.
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keywords = hyperostosis
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19/27. Successful treatment of SAPHO syndrome with zoledronic acid.

    The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a chronic, relapsing, inflammatory condition with skin and osteoarticular manifestations. Its etiology remains unclear, and various treatment regimens with steroids and nonsteroidal antiinflammatory drugs frequently fail to control the disease, while exposing patients to the side effects of these drugs. Because the SAPHO syndrome manifests as a destructive inflammatory bone disease, use of bisphosphonates that possess antiosteoclastic and probably antiinflammatory properties has been suggested to be helpful. To our knowledge, this is the first reported case of successful treatment with zoledronic acid of SAPHO syndrome that was resistant to conventional treatment.
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20/27. Acne fulminans with synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome treated with infliximab.

    Acne fulminans is a syndrome of sudden onset hemorrhagic and ulcerative acne involving the back, chest, and face combined with systemic symptoms. It can be the dermatologic manifestation of the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. Current therapy for acne fulminans consists of wound care, topical and systemic corticosteroids, isotretinoin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Infliximab, a recently developed monoclonal antibody against tumor necrosis factor-alfa, has shown efficacy in the treatment of psoriatic arthritis and ankylosing spondylitis both of which share clinical similarities to the SAPHO syndrome. We report the case of a patient with the SAPHO syndrome and acne fulminans who was treated with infliximab. Ten months after initiating therapy with infliximab, the area of the patient's ulcerative lesions was reduced by 70%. Infliximab might be considered as a treatment option for patients with acne fulminans unresponsive to conventional therapies.
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ranking = 5
keywords = hyperostosis
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