Synovitis,
acne, pustulosis,
hyperostosis, and
osteitis (
SAPHO) syndrome, a rare disorder with a spectrum of manifestations and overlapping osseous and cutaneous symptoms, shares pathogenesis with various
autoimmune diseases. SARS-CoV-2 has been previously linked to various
autoimmune diseases like
Guillain-Barré syndrome (GBS), a multi-inflammatory syndrome in children (MIS-C), or
rheumatoid arthritis, but there is no existing work showing a link between
SAPHO syndrome and
COVID-19 yet. Here, we present a case of a middle-aged Asian male who presented with minimum swelling of his right second toe, 21 days post-COVID. After a series of investigations, namely, MRI scans, 99mTc-methylene diphosphonate three-phase bone scan, and bone biopsy, followed by a positive culture and sensitivity test of the same toe, a trial of
vancomycin was given to the patient to treat bacterial
osteomyelitis. This resulted in no improvement, pointing toward a misdiagnosis. A conclusion of sterile
osteomyelitis of his right second and third metatarsal heads and phalanges due to
SAPHO syndrome, as a possible complication of
SARS-CoV-2 infection, was made. There are a number of classification systems for diagnosing this syndrome, one of which was modified by Kahn and was used in our case. Atypical presentations of rare disorders like
SAPHO syndrome and their relation to
SARS-CoV-2 infection are still to be fully discovered and investigated. Their prevention, timely diagnosis, and management may help in alleviating the discomfort and fear associated with the unknown for the patients.