A case of non-malignant multifocal lesions on the methyl diphosphonate technetium-99m bone scan with enteropathy....

This is a case of a 24-year-old man with non-malignant multifocal bone lesions on the methyl diphosphonate technetium-99m bone scan, that may represent a variant of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. The patient complained for diffuse osseous pain, focused mainly in the hip joints. X-rays of the hips were normal but X-rays of the shoulders showed hyperostosis of the right clavicle with no erosions. SAPHO is a rare syndrome of unknown aetiology with no more than a hundred cases reported during the last 10 years. Its typical form consists of characteristic painful osteoarticular manifestations and dermatological findings. In a variant of this syndrome, such as in our case, dermatological manifestations may be absent, but hyperostosis with osseous hypertrophy and enteropathy are present. No other malignant or benign disease was diagnosed. All routine laboratory tests for an inflammatory rheumatoid disease were negative. Treatment with non steroid anti-inflammatory agents was successful and after six months, there were no clinical symptoms and lesions on the bone scan faded. Four years later the patient remained free from symptoms. We discuss the scintigraphic, radiological laboratory clinical findings, the therapeutic criterion and the exclusion of any malignant or other benign bone disease that suggest the diagnosis of SAPHO syndrome. In conclusion, although we were unable to perform a bone biopsy, we suggest that no other diagnosis but an enteropathic variant of SAPHO syndrome may better describe the above clinical and laboratory findings. Bone scan findings have a principal diagnostic role in SAPHO syndrome.