A 21-year-old man developed severe acne on his face and back over a period of more than five years. At the age of 20, he began to experience pain in the right sternoclavicular joint with limited mobility. Subsequently, he was diagnosed with a broken collarbone. Volumetric rendering computed tomography (VR-CT) images show nearly 1 3 fractures of the patient's right clavicle (Fig. 1A). Over time, the fracture gradually heals.
However, two years later, he had chest pain again. Technetium methyldiphosphonate whole-body imaging showed increased radiotracer uptake in the right clavicle, bilateral sternoclavicular joints, and sternal horns (Fig. 1B). Subsequent CT scans showed that the original fracture line had disappeared, indicating that the fracture had healed well (Figure 1C). Magnetic resonance imaging (MRI) showed an old thoracic fracture of the right clavicle and bone marrow edema of the right sternoclavicular joint (Fig. 1D-E). Based on these imaging tests and his symptoms, he was diagnosed with SAPHO (synovitis, acne, impetigo, hyperostosis, osteitis) syndrome and received zoledronic acid infusion**. After **, his pain lessened. This case is a rare case of Sapho syndrome with a clavicle fracture, in which the fracture occurs spontaneously and repairs on its own.
Figure 1 AB, volumetric rendering computed tomography (VR-CT) image of the right clavicle. Whole-body scintigraphy of methyl bisphosphonate shows an abnormal increase in radioactivity uptake in the right clavicle, bilateral sternoclavicular joints, and sternal angle. Magnetic resonance imaging (MRI) shows an old fracture of the sternal end and bone marrow of the right clavicle, and edema of the right sternoclavicular joint.
Reference: 1nguyen mt，borchers a，selmi c，naguwa sm，cheema g，gershwin me。Sapho syndrome. Semin's arthritis rheum2012；42：254-265。