Bull’s Head Sign in a Patient with SAPHO Syndrome

A 53-year-old male was evaluated for upper chest pain lasting 3 years. The pain was continuous, bilateral, progressive, and worse when the patient lay on his sides and during hyperabduction of the arms, radiating to the shoulders. Initially, it was responsive to non-steroidal anti-inflammatory drugs, but full daily doses of combined long- and short-acting non-steroidal anti-inflammatory drugs had failed in the last few months, resulting in impairment of daily activities and disturbance of sleep, causing the patient to seek medical help. On physical examination, the sternoclavicular, manubriosternal, and upper two costosternal joints on both sides were tender. Systemic examination did not reveal any additional abnormal findings.