Long-delayed onset of chest wall pain defining a patient with SAPHO syndrome.

A 57-year-old woman presented with 2 months history of right chest pain with direct tenderness and swelling over the right sternoclavicular joint. She had a 20-year history of skin rash over both soles and palms suggestive of pustulosis palmaris and plantaris without musculoskeletal symptoms. CT scan of the right sternoclavicular joint showed osteolysis of the joint and adjacent sclerosis. 99mTechnetium bone scan was abnormal with increased uptake over the joint and manubrium. She was diagnosed with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis). This case report emphasizes the long duration that can lapse between onset of initial skin manifestations and musculoskeletal symptoms to define SAPHO syndrome.