The SAPHO syndrome is a rare chronic disease that envolves a group of disorders with osteoarticular and dermatologic manifestations associated. The term SAPHO is related to its main findings: synovitis, acne, pustulosis, hyperostosis and osteitis. This paper presents the case of a female patient, age 51, toothless, that presented to our service complaining about severe pain of the left jaw, and a swelling at the same site that receded through the use of antibiotics and NSAIDs. The patient had been on continuous treatment for rheumatoid arthritis, sinovitys and loss of movement of the upper and lower limb. A panoramic radiograph was performed and showed images of periosteal growth in flakes. A scintigraphy evidenced a strong metabolic activity in the right mandibular body and joints of the knees, elbows, and hands. The patient then underwent a bone biopsy. The histopathology was compatible with new and immature bone with deposition on layers. Surgery was performed to remove the lesion. The confirmed diagnosis of osteitis, associated with other clinical manifestations of the patient as rheumatoid arthritis, pustulosis, synovitis and articular hyperostosis established the diagnosis of SAPHO. Five months after surgery, the patient developed a pathological fracture in the operated area. A surgical access was performed for removal of the necrotic bone and fixation with 2.4 mm reconstruction plate. After an 18 month monitoring with good clinical evolution and no complaints, it was performed rehabilitation of the lower arch with six implants and a protocol prosthesis, being monitored for six years with an excellent outcome.
Conflict of interest: None declared.