SAPHO syndrome is an uncommon clinical entity, recently described in literature, which usually affects children, young adults and middle-aged people. It is defined by the association of skin lesions (severe
acne, palmo-plantar pustulosis, supurative
hidradenitis),
synovitis, hiperosthosis and
osteitis; however, not all manifestations are required for correct diagnosis. We report a currently forty-two year-old man who initiated follow-up in 1992 for severe
acne. His diagnosis changed along the years and has been treated with
antibiotics many times to control pustule formation and
hidrosadenitis, which evolved to keloidal
scars, requiring neck zethaplasty due to limitation of mobility. In 1996
isotretinoin was started, with good response to treatment but recurrence after its completion. Ten years later,
isotretinoin was being used again due to worsening clinical picture when the patient developed
polyarthritis, lost 11kg in 3 months and was found to have an elevated erythrocyte sedimentation rate.
SAPHO syndrome was then diagnosed by the Rheumatology clinic, which started
methotrexate at 10mg per week to a good clinical response. Several cutaneous and articular flares have occurred since, however he is now clinically stable with
methotrexate 20mg per week and
finasteride 5mg per day.
SAPHO syndrome is a
rare disease and its diagnosis is often late and difficult. In this case, skin lesions preceded
arthritis in several years and have been resistant to other common treatments. The patient had a better improve after initiation of
methotrexate. Although the
skin disease has evolved to
keloids, the patient has had excellent treatment response.