PMC8437625_01
Sagittal reconstruction (bone window) shows the aspect of an ivory C5 vertebra.
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fig1
The cervical spine X-ray revealed osteosclerosis of the C5 vertebral body with the aspect of an ivory vertebra which was confirmed on the cervical scanner (Figure 1).
Summary diagram of case 1 diagnosis.
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fig2
As infection and neoplasia were rolled out and as our patient fulfilled Benhamou et al.'s diagnostic criteria, the SAPHO syndrome diagnosis was established (Figure 2).
PMC8437625_02
Magnetic resonance imaging. (a) Sagittal T1 WI, (b) sagittal T2 WI, and (c) sagittal STIR WI showing irregularity of the end plates from D4 to D7, high T2 signal in the disc, marrow signal change in the adjacent vertebra (T1 low and T2 high), and soft tissue mass (arrow). (d, e) Magnetic resonance imaging axial T1 after contrast showing soft tissue microabscess (arrow).
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fig3
Spine MRI showed spondylodiscitis in D3-D4, D4-D5, D5-D6, D6-D7, and L1-L2 and soft tissue involvement, simulating infectious spondylodiscitis (Figure 3).
Summary diagram of case 2 diagnosis. SpA: spondyloarthritis.
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fig4
The diagnosis of SAPHO was then suspected, and bone scintigraphy was performed showing uptake in the chondrosternal articulations and D4 to D7 vertebrae, supporting the diagnosis of SAPHO (Figure 4).
(a-c) Inflammatory marrow signal from T1 to T9 complicated by kyphosis at the top of T7 and associated with inflammatory damage at the anterior chest wall, predominantly the right sternoclavicular joint.
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fig5
A new MRI was then performed showing an inflammatory marrow signal from T1 to T9 complicated by kyphosis at the top of T7 and associated with inflammatory damage at the anterior chest wall, predominantly the right sternoclavicular joint (Figures 5(a)-5(c)).
PMC8437625_03
(a) Sagittal CT image showing osteosclerosis of vertebral bodies of D8 to D12 and L4 with paravertebral ossifications. (b) Axial CT image showing intra-articular bridges and multiple well-defined erosions with sclerotic margins. Bone sclerosis is blurred within the trabecular bone. (c) Magnetic resonance imaging axial T1 WI showing bilateral sacroiliitis with a fatty marrow signal.
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fig6
TAP scan, carried out as part of the extensive assessment of the disease, showed osteosclerosis of vertebral bodies of D8 to D12 and L4 with paravertebral ossification (Figure 6(a)) and bilateral osteosclerosis in the sacroiliac joints with intra-articular bone bridges (Figure 6(b)). The patient reported a history of mechanic low back pain lasting for 20 years but no current flare-up. The patient underwent an MRI that showed bilateral sacroiliitis (Figure 6(c)) and an abnormal signal in the D4 to D11 vertebrae.
Summary diagram of case 3 diagnosis. SpA: spondyloarthritis.
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fig7
Given that the tumor was in remission and there was no recent worsening of the low back pain and considering the intra-articular sacroiliac bone bridges and the involvement of the anterior chest wall, the diagnosis of SAPHO syndrome was established (Figure 7).
CT scan 12 months later showing ankylosis of the sacroiliac joint.
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fig8
A control TAP scan was performed, showing stable spine lesions and ankylosis of the sacroiliac joint (Figure 8).