Case report: remarkable remission of SAPHO syndrome in response to Tripterygium wilfordii hook f treatment

RATIONALE SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is an autoinflammatory disease with no standardized treatment. Tripterygium wilfordii hook f (TwHF) is a Chinese herb with immunosuppressive effects and has been used to treat some chronic inflammatory diseases. However, it has not been reported as a therapeutic option in SAPHO syndrome. Here we present the first report in which a remarkable remission of SAPHO syndrome was achieved in response to TwHF. PATIENT CONCERNS A 57-year-old female patient noted swelling and pain at the anterior chest wall and scattered rashes like psoriasis vulgaris. Bone scintigraphy demonstrated the classic "bull's head" sign and magnetic resonance images indicated bone marrow edema on T5. DIAGNOSES The diagnosis was made by dermatological and osteoarticular manifestations and classical "bull's head" sign in bone scintigraphy. INTERVENTIONS TwHF with a priming dose of 20 mg 3 times per day and a gradual dose reduction of 20 mg per day in every 3 months. Four months later, methotrexate was added with 10 mg per week. OUTCOMES Osteoarticular symptoms and radiological abnormalities were improved dramatically. LESSONS This case illustrates a promising strategy to treat SAPHO syndrome.