A case of SAPHO syndrome with destructive spondylodiscitis suspicious of tuberculous spondylitis

Abstract

We report a rare case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in which the differential diagnosis included tuberculous spondylitis and the patient ultimately required reconstructive spinal surgery. The patient was a 60-year-old woman who presented with severe low-back and leg pain after treatment for tuberculosis. Roentgenography and magnetic resonance imaging of the lumbar spine revealed destructive changes suggestive of tuberculous spondylitis. [¹⁸F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography showed uptake in the cervical spines, lumbar spines, and sacroiliac joints from which she was suspected of having SAPHO syndrome without skin manifestations. However, as her symptoms did not respond to conservative treatment, we performed reconstructive surgery of the lumbar spine. Spinal specimens obtained surgically showed nonspecific inflammation and fibrous hypertrophy of the bone marrow, confirming a diagnosis of the SAPHO syndrome. Her symptoms improved markedly after surgery, although she required occasional prednisolone for moderate polyarthralgia and leg pain.

Keywords::

• Synovitis
• acne
• pustulosis
• hyperostosis
• osteitis syndrome (SAPHO)
• [¹⁸F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography ([¹⁸F] FDG-PET/CT)
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)
• Tuberculous spondylitis