Misdiagnosis of SAPHO Syndrome as Spinal Infection: A Case Report

This report presents a case of SAPHO syndrome misdiagnosed as spinal infection due to lumbosacral pain. Through a literature review, we detailed the disease’s symptoms, signs, laboratory/imaging findings, diagnosis, differential diagnosis and treatment, and analyzed the causes of our misdiagnosis. We emphasize that comprehensive history-taking and improved clinical awareness can effectively reduce misdiagnosis rates. In diagnostic dilemmas, cutaneous lesions (especially palmoplantar pustulosis and acne) and the characteristic bull’s head sign (bilateral sternoclavicular radionuclide uptake) on whole-body bone scintigraphy are highly suggestive of SAPHO syndrome. As SAPHO is not an infectious disease, its treatment differs drastically from antibiotic therapy, and misdiagnosis as infection may delay proper management. This report reminds orthopedic surgeons to remain vigilant for rare diseases in clinical practice. Misdiagnosis rates can be minimized only by expanding professional knowledge, conducting thorough history-taking and physical examinations, and combining these with advanced auxiliary examinations.