SAPHO syndrome masquerading as metastatic bone disease

Area of Science:

• Rheumatology
• Oncology
• Radiology

Background:

• Distinguishing bone metastases from other bone pathologies is crucial in cancer patients.
• SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) can present with bone lesions mimicking metastatic disease.

Observation:

• A post-mastectomy patient presented with bone scintigraphy findings suggestive of widespread bone metastases.
• Radiological imaging confirmed bony lesions, but their appearance was atypical for metastases and raised suspicion for SAPHO syndrome.

Findings:

• Bone biopsies revealed fibrosis and hyperostosis, without evidence of malignancy.
• The patient's history included palmar pustulosis and sacroiliitis, key features of SAPHO syndrome.

Implications:

• This case underscores the importance of considering SAPHO syndrome in the differential diagnosis of bone lesions, even in cancer patients.
• Accurate diagnosis relies on integrating clinical history, radiological findings, and histological examination to avoid misdiagnosis and inappropriate treatment.