Abstract
A 64-year-old woman was referred to our department because of pain over a wide area of her body, including the neck, a shoulder, the anterior chest, and the back, that persisted after fracture dislocation of the shoulder joint. No skin symptom was noted at the initial examination, and autoantibody was negative, suggesting that the possibility of rheumatic disease was low. Because her condition fulfilled the classification criteria for fibromyalgia issued by the American College of Rheumatology, oral administration of amitriptyline and codeine was initiated. A detailed physical examination revealed the presence of anterior chest and back pain from before injury of the shoulder and a thickening of the right sternoclavicular joint. A diagnosis of SAPHO syndrome was made on the basis of bone thickening on MRI and a bull's head sign on bone scintigraphy. Rash later appeared on a foot and was diagnosed as palmoplantar pustulosis. Pain was markedly alleviated by oral bisphosphonate, and the condition ceased to fulfill the classification criteria for fibromyalgia.
