Chronic Osteomyelitis of the Proximal Femur in SAPHO Syndrome with Avascular Necrosis of the Femoral Head : A Case Report

摘要

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is relatively rare, that affects anterior chest wall and spine of the skeleton almost exclusively. A 53-year-old patient man presented with palmoplantar pustulosis and left hip pain. Radiographic and magnetic resonance images exhibited an osteolytic lesion demarcated by a thin sclerotic line in the proximal metaphysis of the left femur and avascular necrosis of bilateral femoral heads. Histological and microbiological examination demonstrated that the metaphyseal lesion was sterile chronic osteomyelitis. He was subsequently diagnosed with SAPHO syndrome. As he had a history of excessive ingestion of alcohol and administration of steroid for pustulosis, we speculate that avascular necrosis was not due to osteomyelitis but alcohol or steroid.