PMC9329683_01
Acne conglobata (A), cutis verticis gyrata (CVG) (B), and knee arthritis (C) before treatment. (D) The pedigree gram of SAPHO family.
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Physical examination on admission revealed numerous papules, pustules, cysts, draining sinus tracts, and hypertrophic scars on the face, part of which coalesced into plaques (Figure 1A). There was CVG on his head (Figure 1B). There was also swelling and tenderness on both knees (Figure 1C). His parents and sister were all normal (Figure 1D).
(A) Radiographic imaging showed a low-density plaque with a sclerotic margin on the right distal tibia (arrow). (B) MRI demonstrated suprapatellar bursa and joint effusion, and circumferential soft tissue edema on the right knee (arrow). (C) Whole-body bone scintigraphy revealed increased radioactivity in the limb bones.
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Radiographic imaging of the lower extremities showed a low-density plaque with a sclerotic margin on the right distal tibia (Figure 2A). The magnetic resonance imaging (MRI) scans of the knee demonstrated a posterior horn tear on the medial meniscus (II ), injury on the medial collateral ligament, injury on the lateral and medial retinacula, suprapatellar bursa and joint effusion, and circumferential soft tissue edema on the right knee (Figure 2B). Whole-body bone scintigraphy revealed a diffuse, slightly increased uptake in the limb bones (Figure 2C).
Acne conglobata and knee arthritis after recombinant human TNF-alpha receptor II:IgG Fc fusion protein (rhTNFR:Fc) treatment: (A and F) 4 months (November 2019); (B and G) 10 months (May 2020); (C and H) 13 months (August 2020); (D and I) 21 months (April 2021). Cutis verticis gyrata (CVG) before (E) and after (J) rhTNFR:Fc treatment.
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A 2-year follow-up showed no relapse of acne and remarkable improvement of joint pain, and his CVG was also improved (Figure 3).