Bone Scan and SPECT/CT Scan in SAPHO Syndrome

Area of Science:

• Rheumatology
• Dermatology
• Nuclear Medicine

Background:

• Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatory disorder.
• It presents with distinct musculoskeletal and dermatologic manifestations, including inflammatory joint and skin lesions.
• Anterior chest wall pain, sternoclavicular/sternocostal joint involvement, palmoplantar pustulosis, and acne are characteristic features.

Purpose of the Study:

• To report a case of SAPHO syndrome in a pediatric patient.
• To illustrate the diagnostic utility of bone scintigraphy and SPECT/CT in identifying the characteristic "bull-head" sign.
• To emphasize the importance of integrating clinical findings with imaging for accurate diagnosis.

Main Methods:

• Case report of a 15-year-old female with anterior chest wall swelling.
• Diagnostic workup included bone scintigraphy and single-photon emission computed tomography (SPECT/CT).
• Physical examination for characteristic skin lesions was performed.

Main Results:

• Bone scintigraphy and SPECT/CT revealed the classical "bull-head" sign, indicative of sternoclavicular hyperostosis.
• Physical examination confirmed the presence of skin lesions consistent with SAPHO syndrome.
• The combination of imaging and clinical findings led to the diagnosis.

Conclusions:

• SAPHO syndrome requires a high index of suspicion, especially in patients with unexplained anterior chest wall pain and skin manifestations.
• Bone scintigraphy and SPECT/CT are valuable tools for diagnosing SAPHO syndrome by visualizing characteristic bony changes.
• Early and accurate diagnosis is crucial for appropriate management of SAPHO syndrome.