An unusual case of pustulotic arthro-osteitis affecting the leg, and erosive polyarthritis

Pustulotic arthro-osteitis is a syndrome, originally described in Japan, in which a sterile inflammatory osteitis of the sternoclavicular region occurs in combination with a non-erosive arthritis, sacroiliitis, and a pustulotic rash on the palms and soles. Although the disease has been reported in white populations, it is rarely seen by rheumatologists in the United Kingdom. The case of a Scottish woman is described in whom the diagnosis of pustulotic arthro-osteitis was overlooked because of an atypical site of the disease--the fibula, an erosive arthritis, and absence of a pustular rash at the time of her presentation with musculoskeletal symptoms. This case shows that the syndrome may easily by missed unless clinical suspicion is high and should be considered in any patient with culture negative osteitis, even outside the sternoclavicular region.