SAPHO syndrome presenting as widespread bony metastatic disease of unknown origin

SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome represents an inflammatory spectrum ranging from an osteitis through to a spondyloarthropathy which may or may not be associated with dermatological manifestations. We present the case of a 52-year-old female who presented with non-specific back pain. Radiological imaging showed mixed lytic and sclerotic lesions of her lumbar spine and pelvis consistent with bony metastatic disease. She underwent CT-guided biopsy that confirmed histological findings in keeping with non-bacterial osteitis/chronic recurrent multifocal osteomyelitis. This case report and review of the literature highlights the importance of the SAPHO syndrome and its treatment.