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April 2013

Palmoplantar Pustulosis Presenting With Chest Pain—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(4):475-480. doi:10.1001/jamadermatol.2013.1998b

Bone scintigraphy showed intense activity at the sternoclavicular and first sternocostal joints (Figure 2). Histopathologic examination of the biopsy specimen demonstrated subcorneal neutrophilic pustules with neutrophils in the papillary dermis, but direct immunofluorescence yielded negative results (Figure 3). These findings were consistent with SAPHO syndrome. A 2-month course of oral prednisolone (20 mg/d) and methotrexate (15 mg/wk) led to clinical improvement. A follow-up visit at 2 months after the end of the treatment revealed no recurrence of the lesions.

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