The first case of 2015 is intended to wake you up after the holidays. The patient is a 68-year-old man who came to our institution last October with pain in the chest and skin lesions. Is the chest normal?
If not, where is the abnormality? Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.
Findings: PA chest shows a rounded haziness at the level of the first costo-chondral junctions (arrows), more evident on the right side. The lateral view only shows degenerative changes in the dorsal spine.
CT shows marked sclerosis of the proximal clavicles, first costo-chondral junction (A, C arrows) and sternal manubrium (B, arrows). The patient also had sacroileitis (D, arrows). On clinical examination, there were pustulous lesions in the sole of the feet.
This combination of findings is highly suggestive of SAPHO syndrome (synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis).
Final diagnosis: SAPHO syndrome
Congratulations to Ivan, who was the first to make the correct diagnosis.
Teaching point: I know this case is difficult and unusual, but we saw it only three months ago (See the date in the CT study). Sometimes we have to be aware that unusual cases can cross our path and be ready to diagnose them.
