A 56-year-old woman presented with a 7-year history of right hand numbness. She had received a diagnosis of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome after presenting with palmoplantar pustulosis and right shoulder pain 18 years earlier and had received analgesics and topical corticosteroids. On her current presentation, dilated superficial veins appeared on her right arm (Picture 1). X-ray of the upper thoracic lesion found hyperostosis of the right clavicle (Picture 2). Three-dimensional bone computed tomography (CT) reconstruction showed costoclavicular space narrowing (Picture 3, arrow). Contrast-enhanced CT revealed subclavian vein stenosis (Picture 4, arrow). Thoracic outlet syndrome (TOS) was diagnosed, and the patient was referred to a specialized center for surgery. Sternocostoclavicular hyperostosis is highly characteristic of SAPHO syndrome. TOS secondary to this condition is rare, but a case requiring rib resection has been reported. Clinicians should be vigilant for TOS development, which requires surgical intervention (1).
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The authors state that they have no Conflict of Interest (COI).
References
- 1. Ohida H, Curuk C, Prescher H, Stegemann E, Bürger T. Thoracic outlet syndrome in a patient with SAPHO syndrome - a case report. Int J Surg Case Rep 80: 105710, 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]