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February 2007

Overlapping Neutrophilic Dermatosis in a Patient With SAPHO Syndrome

Arch Dermatol. 2007;143(2):264-276. doi:10.1001/archderm.143.2.275

We report herein a case of overlapping neutrophilic dermatosis in a patient with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteomyelitis).

A 52-year-old white woman was admitted to the hospital 1 week after experiencing sudden-onset inflammatory low-back pain and asymptomatic skin lesions. Her medical history was remarkable for autoimmune thyroiditis treated with L-thyroxine. On examination, the patient was fatigued and afebrile. She complained of permanent lumbar spine pain increased by direct pressure on L1 and L5, with radiation of pain in the left buttock, and marked tenderness over the left sacroiliac joint. Vesiculopustules involved the palms and soles and the backs of the hands and feet. Flaccid-looking pustules on a red base and an ulcerated and crusted lesion with a pustular rim discharging a purulent and hemorrhagic exudate were present on the dorsum of the right hand, which suggested atypical Sweet syndrome and pyoderma gangrenosum (Figure).

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