Astonishing improvement of destructive mandibular osteomyeli
A 61‐year‐old man with a long history of repetitive inflammatory acne had a 24‐month history of pain, burning sensation, and swelling of the bilateral mandibles. He was diagnosed with mandibular osteomyelitis. CT and magnetic resonance imaging of the axial bones revealed a new osteolytic lesion on the left clavicle. He was diagnosed with SAPHO syndrome based on the presence of idiopathic sterile osteomyelitis, chronic recurrent multifocal osteomyelitis, and a long history of repetitive inflammatory acne after exclusion of infection or malignancy.

By a widely acknowledged standard regimen for the treatment of SAPHO syndrome with etodolac (400 mg/day) and minocycline (200 mg/day) for 4 months, his pain and inflammatory markers showed definite improvements with marked regeneration of mandibular bone on CT.

SAPHO syndrome must be considered in patients with sterile osteomyelitis, even in unusual sites, and especially with a history of skin involvement or even slight abnormalities within axial bones in imaging tests.

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