SAPHO-like bone scintigraphy in diffuse idiopathic skeletal hyperostosis: a case report.
7 affiliations
- 1Weifang Nursing Vocational College, Weifang, Shandong, China.
- 2Department of Emergency Internal Medicine, Weifang People's Hospital, Weifang, Shandong, China.
- 3Department of Thoracic Surgery, Weifang People's Hospital, Weifang, Shandong, China.
- 4School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
- 5Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China.
- 6Department of Dermatology, Tianjin Institute of Integrative Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
- 7Department of Rheumatology, Weifang People's Hospital, Weifang, Shandong, China.
Abstract
Background
Bone scintigraphy is sensitive to increased osteoblastic activity but is not disease specific. Diffuse idiopathic skeletal hyperostosis (DISH) may therefore be mistaken for synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome when uptake involves the anterior chest wall and spine.Case presentation
A 50-year-old woman presented with a 1-year history of painless left sternoclavicular prominence. She reported that her daughter had SAPHO syndrome with anterior chest wall pain and palmoplantar pustulosis. Whole-body 99mTc-MDP scintigraphy and single-photon emission computed tomography showed uptake in the left sternoclavicular joint and multiple cervical and thoracic vertebrae. However, the patient had no inflammatory pain, skin lesions, or marked systemic inflammatory response. A low-dose whole-spine CT demonstrated flowing anterolateral ossification across multiple contiguous thoracolumbar vertebrae with preserved disc spaces; a sacroiliac CT showed no erosive sacroiliitis. A sternoclavicular MRI showed no bone marrow edema. These findings supported DISH. During 3 years of follow-up, no skin disease or osteitis-related symptoms developed.Conclusion
DISH should be considered when SAPHO-like scintigraphy is discordant with the clinical findings and CT/MRI evidence. A six-step approach integrating symptoms, skin findings, metabolic and medication history, MRI, CT, and follow-up may help assess this discordance, but this has not been validated.
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BibTeX
@article{wang2026sapholike,
title = {{SAPHO-like bone scintigraphy in diffuse idiopathic skeletal hyperostosis: a case report.}},
author = {Xiaolei Wang and Yuwei Wang and Guangying Zhang and Hongxu Liu and Sheng-Guang Li and Chen Li and Yuying Zhang and Di Jin},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1967844},
url = {https://europepmc.org/article/MED/42909372},
note = {CC BY},
}
RIS
TY - JOUR
TI - SAPHO-like bone scintigraphy in diffuse idiopathic skeletal hyperostosis: a case report.
AU - Xiaolei Wang
AU - Yuwei Wang
AU - Guangying Zhang
AU - Hongxu Liu
AU - Sheng-Guang Li
AU - Chen Li
AU - Yuying Zhang
AU - Di Jin
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1967844
UR - https://europepmc.org/article/MED/42909372
AB - Background Bone scintigraphy is sensitive to increased osteoblastic activity but is not disease specific. Diffuse idiopathic skeletal hyperostosis (DISH) may therefore be mistaken for synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome when uptake involves the anterior chest wall and spine.Case presentation A 50-year-old woman presented with a 1-year history of painless left sternoclavicular prominence. She reported that her daughter had SAPHO syndrome with anterior chest wall pain and palmoplantar pustulosis. Whole-body 99mTc-MDP scintigraphy and single-photon emission computed tomography showed uptake in the left sternoclavicular joint and multiple cervical and thoracic vertebrae. However, the patient had no inflammatory pain, skin lesions, or marked systemic inflammatory response. A low-dose whole-spine CT demonstrated flowing anterolateral ossification across multiple contiguous thoracolumbar vertebrae with preserved disc spaces; a sacroiliac CT showed no erosive sacroiliitis. A sternoclavicular MRI showed no bone marrow edema. These findings supported DISH. During 3 years of follow-up, no skin disease or osteitis-related symptoms developed.Conclusion DISH should be considered when SAPHO-like scintigraphy is discordant with the clinical findings and CT/MRI evidence. A six-step approach integrating symptoms, skin findings, metabolic and medication history, MRI, CT, and follow-up may help assess this discordance, but this has not been validated.
SN - 2296-858X
ER -