Small-cell Lung Cancer Associated with SAPHO Syndrome

A 58-year-old woman presented with chest pain and dyspnea. Chest computed tomography (CT) revealed a bulky mediastinal mass compressing the trachea and enlargement of the contralateral hilar lymph nodes (Picture 1). Endobronchial ultrasound-guided transbronchial needle aspiration was performed, and the pathological diagnosis was small-cell lung cancer (SCLC). Bone scintigraphy revealed the RI (Radioisotope) uptake in the sternoclavicular joints. However, CT showed no metastasis to the bone (Picture 1). Tenderness of the sternoclavicular joint, acne, palmoplantar pustulosis of hands and planta pedis were observed. Based on these findings, we diagnosed the patient with “synovitis, acne, pustulosis, hyperostosis, osteitis” (SAPHO) syndrome (Picture 2). The patient received platinum-based chemotherapy (carboplatin AUC 5 on day 1; etoposide 100 mg/m on days 1, 2 and 3) for 4 cycles without concurrent radiotherapy because of contralateral hilar lymph node metastasis. Chest CT revealed a marked reduction of the tumor (Picture 3). The tenderness of the sternoclavicular joint and the skin findings gradually improved and disappeared after chemotherapy (Picture 4). SAPHO syndrome is a rare disorder, and few cases with comorbid lung cancer have been re-