SAPHO syndrome may be treated effectively with combined drug regimens - A case report

Introduction: Because SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) is a rare syndrome, its treatment is controversial. We are presenting a case of a patient with SAPHO syndrome, who was treated with combined drug regimen. Case Report: A 16year-old man was admitted to our hospital with hip and back pain for one month. The patient was not able to move his thighs; therefore he could not walk because of pain. He had papullopustular acne on his back and face. Also, the patient had a mild pain on upper chest wall caused by sternoclavicular arthritis. The erytrocyte sedimentation rate was 69 mm/1sthour and C-reactive protein was 2.8 mg/dl. HLA B27 was positive. Magnetic resonance imaging of the sacroiliac joint revealed a bilateral symmetrical sacroiliitis. Whole body Tc 99m-MDP bone scintigraphy detected bull’s head sign. A diagnosis of SAPHO syndrome was made. The patient was treated with NASIDs, isotretinoin, sulphasalasine, methotrexate, hydroxychloroquine and methylprednisolone. Two weeks later, his pain was relieved. Two years later he is still on complete remission. Conclusion: SAPHO syndrome may be treated with combined drug regimen to obtain complete remission and relieve pain.