PMC5447692_01
(A) Acne in right lower limb, which spread to patient's face, limbs, and trunk; (B, C) palmoplantar pustulosis.
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After the fifth adalimumab shot, she visited our outpatient clinic with complaints of a tender shoulder and left clavicle and acne spreading over her trunk, limbs, and face (Figure 1A).
Computed tomography scan of clavicles. Erosion in right clavicle (white arrow).
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C). She was referred to a rheumatologist in a tertiary hospital and received radiological examination, which supported the diagnosis of SAPHO syndrome. Computerized tomography showed bone erosions with edema in the bilateral sternoclavicular joints (Figure 2).
Bone-scintigraphy findings showed intensive uptake of 99mTc at the sternoclavicular joints and sternum, called a "bull's head" sign.
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Additionally, bone-scintigraphy findings showed extensive uptake of radiopharmaceutical 99mTc at the sternoclavicular joints and sternum, which is called a "bull's head" sign (Figure 3).