Stemocostoclavicular hyperostosis (SCCH) is a very uncommon disease characterized by hyperostosis of the clavicle, upper ribs, sternum and soft tissue ossification, particularly of the costoclaviculr ligament. Although the cause of this disorder is unknown, clinical, radiological and histological examinations may allow the diagnosis of SCCH. This paper presents a case of SCCH and a brief review of the literature.
Biopsy ; Case Report ; Clavicle/pathology ; Diagnosis, Differential ; Human ; Hyperostosis, Sternocostoclavicular/*diagnosis ; Korea ; Male ; Middle Age

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Antirheumatic Agents ; Diagnosis ; Diagnosis, Differential ; Hyperostosis ; Hyperostosis, Sternocostoclavicular ; Inflammation ; Osteomyelitis ; Psoriasis ; Skin Manifestations ; Spine ; Spondylarthropathies ; Thoracic Wall ; Infliximab

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Antirheumatic Agents ; Diagnosis ; Diagnosis, Differential ; Hyperostosis ; Hyperostosis, Sternocostoclavicular ; Inflammation ; Osteomyelitis ; Psoriasis ; Skin Manifestations ; Spine ; Spondylarthropathies ; Thoracic Wall ; Infliximab

Sternocostoclavicular hyperostosis is a chronic arthro-osteitis affecting mostly jux-tasternal structures. It is characterized clinically by painfull swelling of the upper anterior chest wall and occasionally is associated with pustulosis palmaris and plantaris. A 34-year-old female presented with upper anterior chest pain and low back pain. She was well until three months ago, then left shoulder pain and multiple pustule on both palms developed. She felt gradually exhausted in spite of symptomatic medication at drug store. Eight months before this admission she underwent an operation on the right sided breast due to a benign mass. On examination there was no evidence of conjunctivitis or aphthous oral ulcer, tenderness on left sternoclavicular joint was noted and flextion of the left hip joint was limited because of pain in the joint area. Multiple pustules were noted in the palms of both hands, but it wasn't associated with nail change. The mammographs was normal. Plain radiographs of the spine showed disc space narrowing of seventh thoracic spine and spondylolysis on fifth' lumbar vertebra. Radionuclide imaging with 99mTc-methylene diphosphonate of the bone showed multiple increased uptake on both sacroiliac joints, both first costochondra] joints, left sternoclavicular joint, and eighth thoracic vertebra. Magnetic Resonance Imaging reavealed low signal intensity in medial end of the left clavicle with joint effusion and Schmorl's node in seventh thoracic disc space. Laboratory tests were normal, except ESR 23mm/h. In this case we think that careful clinical differential diagnosis of sternocostoclavicular hyperostosis should include sclerotic metastasis.
Adult ; Breast ; Chest Pain ; Clavicle ; Conjunctivitis ; Diagnosis, Differential* ; Female ; Hand ; Hip Joint ; Humans ; Hyperostosis, Sternocostoclavicular* ; Joints ; Low Back Pain ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Oral Ulcer ; Radionuclide Imaging ; Sacroiliac Joint ; Shoulder Pain ; Spine ; Spondylolysis ; Sternoclavicular Joint ; Technetium Tc 99m Medronate ; Thoracic Wall