Vertebral destruction with severe pain in the SAPHO syndrome

History and admission findings: A 57-year-old man had for the past 18 month s complained of recurrent, recently worsening, belt-like backache radiating ventrally. On admission a skin rash consisting of blister and pustules was noted on the palms of both hands. He had pain on pressure over the right u pper abdomen, an enlarged prostate and definite pain an percussing the vert ebral column with restricted movement of the thoracic Vertebral column, but no other physical signs. Investigations: Radiology revealed clearly increased sclerosis of several t horacic vertebrae with osteolytic destruction and a paravertebral soft tiss ue tumor. Search for a primary tumor was unsuccessful. Bone scintigraphy de monstrated nuclide enrichment of the thoracic vertebrae and of the sternocl avicular joints without increase in the LeukoScan(R). These findings indica ted the diagnosis of SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis -osteomyelitis). Treatment and course: Rapid subjective and objective improvement followed t he administration of clindamycin and ibuprofen. Conclusion: In case of bone pain of uncertain aetiology, especially when as sociated with skin rash, the rare SAPHO syndrome should be considered in th e differential diagnosis, avoiding lengthy diagnostic steps and allowing ea rly treatment.