University of Wisconsin–Madison Medical College of Wisconsin

A Case of Atypical Synovitis-Acne-Pustulosis-Hyperostosis-Osteitis (SAPHO) Syndrome Presenting with Osteomyelitis of the Clavicle

Chetan Sharma, MD; Brian Chow, MD

WMJ. 2019;118(1):87-88

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Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is considered after exclusion of infection and arthritis;  however, microbial infection may be present in osteoarticular lesions of these patients. Chronic osteomyelitis and associated bacterial infection were detected in a recurrent osteoarticular lesion in an adolescent patient with a history of clavicle pain, who complained of recurrent swelling in the left clavicle. Most pediatric case reports of SAPHO syndrome describe patients with associated skin conditions. This case report describes a patient diagnosed with SAPHO syndrome with no associated skin condition. Although SAPHO syndrome is characterized by dermatological and osteological symptoms, this acronym describes a collection of recurring symptoms. Complete patient medical history and thorough testing, including radiology and biopsy, are critical for prompt diagnosis and treatment of this condition, particularly in pediatric patients with persistent skeletal pain.

Author Affiliations: Department of Pediatrics, Marshfield Clinic and Saint Joseph’s Hospital, Marshfield, Wis (Sharma); Department of Internal Medicine-Pediatrics Infectious Disease, Tufts Medical Center, Boston, Mass (Chow).
Corresponding Author: Chetan Sharma, MD, Department of Pediatrics, Marshfield Clinic GE1, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.387.5251; e-mail
Acknowledgement: The authors thank the Marshfield Clinic Research Foundation’s Office of Scientific Writing and Publication for assistance in preparing this manuscript.
Funding/Support: None declared.
Financial Disclosures: None declared.
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