Multiple imaging findings in SAPHO syndrome

SAPHO syndrome is an acronym for a clinical entity characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The association of sterile inflammatory bone lesions and neutrophilic skin eruptions is indicative of this syndrome, even though not all components always coexist. We report a case of a 62-year-old female presenting with a lytic manubrial lesion. Diagnoses of metastasis or infection were initially entertained but excluded on open biopsy, and SAPHO syndrome was confirmed on additional investigation and follow-up. Striking imaging findings included intense uptake on bone scintigraphy, photopenia on white blood cell imaging, and dramatically elevated lumbar spine bone density on dual energy x-ray absorptiometry (DXA).