SAPHO Syndrome Misdiagnosed as Spinal Infection: A Case Series

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare autoinflammatory disorder characterized by osteoarticular symptoms and dermatological lesions. This case series aims to enhance clinical recognition and reduce misdiagnosis by presenting three patients initially misdiagnosed with spinal infection at external hospitals. All cases presented with worsening back pain and recurrent palmoplantar pustulosis (PPP), one of whom also had comorbid psoriasis. Imaging revealed multifocal purely osteolytic lesions in one patient and mixed osteolytic-osteosclerotic changes in the other two. After exclusion of infectious and neoplastic etiologies, all patients were diagnosed with SAPHO syndrome and showed significant improvement with symptomatic treatment. In conclusion, this case series demonstrated that SAPHO syndrome should be considered in patients with back pain and PPP after excluding infection and tumor.