Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 708 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGE
Year : 2019  |  Volume : 34  |  Issue : 4  |  Page : 349-350  

Bone scan and SPECT/CT scan in SAPHO syndrome


Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication23-Sep-2019

Correspondence Address:
Dr. Nitin Gupta
Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi - 110 060
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_139_19

Rights and Permissions
   Abstract 


Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare clinical entity involving musculoskeletal and dermatologic systems. Its main features are prominent inflammatory cutaneous and articular manifestations. Anterior chest wall pain, more commonly at sternoclavicular and sternocostal joints, along with palmoplantar pustulosis and acne can point to this uncommon syndrome. Here, we report a case of a 15-year-old female, who presented with swelling at the anterior chest wall, was referred for the bone scan. Bone scintigraphy and single-photon emission computed tomography (SPECT/CT) detected classical “bull-head” sign, and further physical examination, for skin lesions, confirmed the diagnosis.

Keywords: Acne, bone scan, hyperostosis and osteitis syndrome, pustulosis, single-photon emission computed tomography-computed tomography, synovitis


How to cite this article:
Gupta N, Verma R, Belho ES. Bone scan and SPECT/CT scan in SAPHO syndrome. Indian J Nucl Med 2019;34:349-50

How to cite this URL:
Gupta N, Verma R, Belho ES. Bone scan and SPECT/CT scan in SAPHO syndrome. Indian J Nucl Med [serial online] 2019 [cited 2019 Oct 22];34:349-50. Available from: http://www.ijnm.in/text.asp?2019/34/4/349/267508



A 15-year-old female with a history of pain and swelling in the anterior chest wall, centered at bilateral clavicular regions for 8 months, was referred for bone scintigraphy. A complete blood count, erythrocyte sedimentation rate, and serum C-reactive protein were normal. Whole-body bone scan anterior and posterior images [Figure 1]a and [Figure 1]b revealed increased tracer uptake in bilateral sternoclavicular joints (left >> right), left clavicle, sternum, bilateral first sternocostal joints and bilateral sacro-iliac joints. The images show intense tracer uptake at the sternoclavicular joints and sternum, which represent a “bullhead” sign, described in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. It was first described by Freyschmidt and Sternberg.[1] Single-photon emission computed tomography–computed tomography (SPECT-CT) scan was also done for further evaluation. Computed tomographic three-dimensional reconstruction [Figure 1]c of the bones of the anterior chest wall showed hyperostosis of the left clavicle. Fused SPECT-CT coronal and axial images [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 1]g showed expansile osteolytic, sclerotic destructive lesions in bilateral clavicles and chondral ends of bilateral first ribs (left >> right). The characteristic “bullhead” sign raises suspicion of SAPHO syndrome. On physical examination, rashes were detected on the palms and soles of the patient. The diagnosis of SAPHO syndrome was considered based on the presence of one of the diagnostic criteria formulated by Benhamou et al.[2]
Figure 1: Whole-body bone scan anterior and posterior images (a and b) show increased tracer uptake in bilateral sternoclavicular joints (left >> right), left clavicle, sternum, bilateral first sternocostal joints, and bilateral sacroiliac joints. Computed tomographic three-dimensional reconstruction (c) of the bones of the anterior chest wall shows hyperostosis of the left clavicle. Fused single-photon emission computed tomography-computed tomography coronal and axial images (d-g) show expansile osteolytic, sclerotic destructive lesions in bilateral clavicles and chondral ends of bilateral first ribs (left >> right)

Click here to view


The acronym SAPHO was introduced in 1987.[3] Few case reports of SAPHO syndrome have been discussed in the literature.[4],[5],[6],[7],[8] Osteoarticular manifestations involve osteitis, hyperostosis, synovitis, arthropathy, and enthesopathy that present with pain, tenderness, and sometimes swelling over the affected areas and fever. Classical cutaneous lesions seen in SAPHO patients include palmoplantar pustulosis and severe acne.[9] Skin lesions may vary in severity and may precede (in 50% of the cases), follow, or occur simultaneously with the onset of arthritis.[10] The present case highlights the importance of bone scan, SPECT-CT imaging, and physical examination to produce a definite diagnosis of SAPHO.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Freyschmidt J, Sternberg A. The bullhead sign: Scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis. Eur Radiol 1998;8:807-12.  Back to cited text no. 1
    
2.
Benhamou CL, Chamot AM, Kahn MF. Synovitis-Acne-Pustulosis Hyperostosis-Osteomyelitis syndrome (SAPHO). A new syndrome among the spondyloarthropathies? Clin Exp Rheumatol 1988;6:109-12.  Back to cited text no. 2
    
3.
Chamot AM, Benhamou CL, Kahn MF, Beraneck L, Kaplan G, Prost A, et al. [Acne-pustulosis-hyperostosis-osteitis syndrome. Results of a national survey 85 cases]. Rev Rhum Mal Osteoartic 1987;54:187-96.  Back to cited text no. 3
    
4.
Canbaz F, Gonullu G, Baris S, Selcuk MB, Bicakci N. SAPHO syndrome without dermatologic manifestations: Multifocal uptake mismatch on 99mTc-MDP and 18FDG-FDG-PET/CT imaging. Hell J Nucl Med 2010;13:73-5.  Back to cited text no. 4
    
5.
Abuhid IM, Silva LC, Martins GP, de Rezende NA. Diagnosing SAPHO syndrome in suspected metastatic bone tumors. Clin Nucl Med 2010;35:172-4.  Back to cited text no. 5
    
6.
İlgen U, Turan S, Emmungil H. Bull's head sign in a patient with SAPHO syndrome Balkan Med J 2019;36:139-40.  Back to cited text no. 6
    
7.
Song X, Sun W, Meng Z, Gong L, Tan J, Jia Q, et al. Diagnosis and treatment of SAPHO syndrome: A case report. Exp Ther Med 2014;8:419-22.  Back to cited text no. 7
    
8.
Seven B, Varoglu E, Erdem T, Atasoy M. Bone scintigraphy results in a patient with sapho syndrome. Eurasian J Med 2008;40:157.  Back to cited text no. 8
    
9.
Monsour PA, Dalton JB. Chronic recurrent multifocal osteomyelitis involving the mandible: Case reports and review of the literature. Dentomaxillofac Radiol 2010;39:184-90.  Back to cited text no. 9
    
10.
Hayem G, Bouchaud-Chabot A, Benali K, Roux S, Palazzo E, Silbermann-Hoffman O, et al. SAPHO syndrome: A long-term follow-up study of 120 cases. Semin Arthritis Rheum 1999;29:159-71.  Back to cited text no. 10
    


    Figures

  [Figure 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed56    
    Printed0    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal