SAPHO syndrome

Discussion:

The patient presented with non-specific pain and skin lesions at time point zero and a diagnosis of SAPHO was made. Two years later, the patient re-presented with pain and swelling of the right knee joint and a mildly elevated C-reactive protein 10 mg/L (normal: <5 mg/L). The follow-up radiographs of the right knee were consistent with an underlying aggressive process.

Joint aspiration showed no organisms.

Specimen: synovial fluid
Crystals: no birefringent crystals seen
Gram Stain: no organisms seen
Leukocytes: 1+
Erythrocytes: scant

Culture: No growth

MRI and clinical assessment were in agreement that the patient had presented for the second time with an acute on chronic episode of sterile osteomyelitis with associated synovitis.

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