Bone scintigraphy results in a patient with sapho syndrome.

Fig. 2 A 41-year-old man who suffered from pain in several joints for more than 10 years was referred for a bone scintigraphy. The patient was treated with non-steroidal anti-inflammatory drugs, but this treatment regimen did not result in a reduction of symptoms. Upon completion of the physical examination, no remarkable findings were noted. All routine laboratory tests were normal. The images obtained after intravenous injection of 740 MBq (20 mCi) Tc-99m methylene diphosphonate (MDP) showed an increased activity in the lateral upper corner of the left orbit, the maxilla, the mandible, the sternoclavicular joints, the left femoral shaft, and especially in the bilateral patella and the medial malleolus at the lower end of the patient’s tibia (Fig. 1). An increased uptake was also observed in the distal tip of the ulna, the interphalangeal joints, the metacarpal bones and bilaterally in the metatarsal bones (Fig. 2). Synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis are symptoms of the disease SAPHO, a name created by combining the first letters of the disease symptoms. While the etiopathogenesis of this disease remains unclear, its typical form consists of characteristic painful osteoarticular manifestations and dermatological symptoms. In a variant form of this syndrome, such as observed in this case study, the dermatological manifestations may be absent, but the hyperostosis with osseous hypertrophy are present. A Tc-99m MDP bone scintigraphy demonstrates osteosclerosis and hyperostosis of the affected bones and is a valuable diagnostic method when considering a therapeutic approach for this disease [1,2].