FDG PET Helpful for Diagnosing SAPHO Syndrome

A 45-year-old man had chronic osteomyelitis in the right tibia since 1996 and developed severe shoulder pain recently. Bone scintigraphy was performed to exclude additional osteomyelitis originating from the primary site. Because of the bone scan results, the presence of osteomyelitis in the sternoclavicular region turned out to be very unlikely. To exclude malignancy, fluorodeoxyglucose positron emission tomography was performed. Further examination showed that the patient had palmoplantar pustulosis. This pattern led to the diagnosis of SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. In this case the positron emission tomographic scan, in addition to bone scintigraphy, showed that in SAPHO syndrome certain areas are active (right ankle region) whereas the activity of the disease in other parts of the body has burned out (thoracic lesions).