PMC5228671_01
Pustules on the palms and soles suggestive of palmoplantar pustulosis (PPP) were shown (A,B). The "bull's head sign" was demonstrated on 99mTc-MDP bony scintigraphy (C). PPP = palmoplantar pustulosis.
medi-96-e5724-g002.jpg
PMC5228671_01_medi-96-e5724-g002.jpg
F1
PPP. PPP was observed on physical examination (Fig. 1A-B). Characteristic "bull's head sign," which was caused by the tracer uptake in bilateral sternoclavicular joints, bilateral costosternal joints, and manubriosternal joint, was observed on bony scintigraphy (Fig. 1C). CT and
(A-F) Coronal CT (A) and MRI (B) of the lumbar spine showed multiple asymmetrically distributed vertebral corner lesions (arrows). Corresponding axial CT (C, E) and MR (D, F) images demonstrated that the vertebral lesions mainly involved the vertebral corners, manifesting as cortical erosions and slight osteosclerosis as well as abnormal signal intensities in surrounding cancellous bone (arrows). (G, H) Coronal MRI of the right hand revealed thickened synovial membranes of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, as well as joint effusion. CT = computed tomography, MCP = metacarpophalangeal, MRI = magnetic resonance imaging, PIP = proximal interphalangeal.
medi-96-e5724-g003.jpg
PMC5228671_01_medi-96-e5724-g003.jpg
F2
MRI of the whole spine demonstrated multiple vertebral corner lesions in lumbar spine (Fig. 2A-F). MRI of the right hand revealed thickened synovial membrane of PIP and metacarpophalangeal (MCP) joints, as well as joint effusion (Fig. 2G-H).