We present the case of an 80-year-old woman with a 10-year history of hypertension, arrhythmia, ischemic heart disease, hyperlipidaemia, neuritis and gastritis. She had been treated with amlodipine besilate, pilsicainide hydrochloride, ubidecarenone, dipyridamole, nitroglycerin, simvastatin, mecobalamin, tocophenol acetate, etizolam and nizatidine. In 2006, she experienced frequent urination. A detailed examination was conducted and she was later diagnosed with bladder cancer. She had undergone TUR and adjuvant treatment with BCG immunotherapy. Post-treatment, the patient is stable without recurrence of disease.
She had experienced palmoplantar pustular skin lesions in October 2008 () and received topical therapy that included tacalcitol and diphenhydramine laurylfate. In the past 1 month, she additionally complained about progressive breath- and movement-dependent pain of the sternum.
Laboratory examination revealed no inflammatory reaction, C-reactive protein level of 0.04 mg/dl (normal: <0.05 mg/dl) and white blood cell count of 5600/mm3 (normal: 3900–9000/mm3).Biochemistry results were as follows: aspartate aminotransferase, 18 IU/l (normal: <32 IU/l); alanine aminotransferase, 19 IU/l (normal: <34 IU/l); -glutamyl transpeptidase, 7 IU/l (normal: 8–60 IU/l); lactic dehydrogenase, 176 IU/l (normal: 250–450 IU/l); alkaline phosphatase, 299 IU/l (normal: 93–271 IU/l); and creatinine, 0.72 mg/dl (normal: <1 mg/dl).
We performed a bone scintigraphy (), which showed abnormal uptake in sternocostoclavicular joint. She typically presented with a musculoskeletal complaint, frequently localised to the anterior chest wall, and skin involvement occurred simultaneously with bone manifestation. On the basis of the results of the physical and radiographic examination, SAPHO syndrome was diagnosed.
Bone scintigraphy of whole body showing abnormal uptake in the sternoclavicular joint, especially strong accumulation in manubrium of sternum and mild accumulation in sternocostoclavicular joint.
The patient received physical therapy that included NSAIDs for chest pain and topical therapy for skin involvement. Treatment was successful, and after 6 months, there were no clinical symptoms.