Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome presenting with a cervical vertebral fracture: A case report

Abstract

Background context: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare condition that can be difficult to diagnose. There are no guidelines for the treatment of SAPHO syndrome, but newer modalities of medications show promising results. We present the case of a patient who presented with a pathologic fracture of her cervical spine who ended up being diagnosed with SAPHO syndrome. Case: A 51-year-old female presented with severe neck pain and a rash on her hands and feet. Imaging showed a C5 vertebral compression fracture and multiple sites of bony involvement concerning for malignancy or widespread infection. The patient underwent corpectomy and fusion to address the instability and cervical stenosis and was started on immunomodulating therapy. Based on the biopsy findings showing left shifted bone marrow versus mild acute inflammation, and in conjunction with the cutaneous findings, the patent was diagnosed with SAPHO syndrome. Outcome: At two year follow up, although posterior stabilization was required, her overall condition was improved. Nonetheless, she continued to have fatigue, malaise, and total body pain involving: the cervical spine, the mid thoracic spine, the left costal margin, bilateral sternoclavicular joints, and bilateral hips and knees. Conclusion: SAPHO syndrome can mimic infection and neoplasia. It should be suspected in patients presenting with multifocal osteitis and associated rash. Accurate and timely diagnosis is paramount as the treatment of this condition may require immunomodulating agents.

Keywords

• SAPHO
• Infection
• Neoplasia
• Fracture
• Osteitis