SAPHO Presenting with a Lesion in the Symphysis Pubis

SAPHO is an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis. It is used to define characteristic bone or joint lesions associated with either pustulosis palmoplantaris or acne. The bone lesions are characterized by sclerosis and hyperostosis, and there may be an associated synovitis. These bone lesions occur most frequently in the anterior thoracic wall, but may be found elsewhere. The lesions tend to have a benign course, and usually are treated with nonsteroidal anti-inflammatory drugs (NSAIDs). The etiology of the SAPHO syndrome is unknown at present. We report the following case because the patient presented with involvernent of the pubis, with a symptomatic osteitis pubis. The presence of palmoplantar pustulosis allowed proper identification of the disease.Characteristic sclerotic bone lesions, found usually in the anterior thoracic wall and associated with palmoplantar pustulosis, were initially de-scribed in Japan in 1967 (1); several similar descriptions followed (2-6). Similar skeletal lesions have also been found associated with other dermatology disorders, mainly acne conglobata (7-13). These bony lesions may occur in various sites in the axial skeleton and occasionally in peripheral bones, where they may be associated with an inflammatory synovitis. In 1987, the acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) was coined to refer to this cluster of cutaneous and osteoarticular manifestations (14).Although involvement of the symphysis pubis has occasionally been mentioned in patients with SAPHO (14, 15), the features of the disease in this particular joint have not been described. In this report, we describe the case of a woman with palmoplantar pustulosis who was seen for pubic pain and sclerotic bone lesions akin to those of SAPHO.