What question did this study set out to answer?

To present a case of SAPHO syndrome with imaging findings and evaluate treatment effectiveness.

January 25, 2026

Bull’s head sign and palmar pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis syndrome: Case report and literature review

Key Points

To present a case of SAPHO syndrome with imaging findings and evaluate treatment effectiveness.
Case report of a 45-year-old woman with chest and back pain and palmar pustulosis.
Imaging studies included bone scintigraphy and assessments for clavicular hyperostosis.
Treatment involved NSAIDs followed by intravenous zoledronic acid for inadequate response.
Imaging revealed clavicular hyperostosis and axial skeleton lesions consistent with SAPHO syndrome.
Bone scintigraphy showed the classic bull’s head sign.
Intravenous bisphosphonate treatment resulted in rapid and sustained clinical improvement.

Abstract

Abstract Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) syndrome is a rare autoinflammatory disorder characterized by osteoarticular and cutaneous involvement. The anterior chest wall and axial skeleton are most frequently affected. Diagnosis relies on clinical presentation and characteristic imaging findings. We report the case of a 45-year-old woman presenting with anterior chest pain, inflammatory back pain, and palmar pustulosis. Imaging revealed clavicular hyperostosis and axial skeletal lesions compatible with SAPHO syndrome. Bone scintigraphy demonstrated the classic “bull’s head sign.” Initial treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was insufficient, leading to the administration of intravenous zoledronic acid, which resulted in rapid and sustained clinical and biological remission. This case highlights the utility of multimodal imaging in the diagnosis of SAPHO syndrome and supports the efficacy of bisphosphonates as a therapeutic option in patients with suboptimal response to NSAIDs.

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