頚椎と腰椎に同時に脊椎炎を発症したSAPHO症候群の1例

Simultaneous Spondylitis in the Cervical and Lumbar Spine in SAPHO Syndrome : Case Report

　抄録：SAPHO症候群とは骨関節病変と皮膚病変により構成される症候群で，脊椎病変の発生頻度は約30％程度とされる．症例は53歳，女性で，頚椎・腰椎に同時に脊椎炎を認めた．さらに掌蹠膿疱症の合併と骨シンチグラムにて胸肋鎖骨部の病変が発見された．皮膚病変を伴わない例，頻度の低い骨病変など典型的所見を伴わない例では化膿性骨髄炎や悪性腫瘍との鑑別が必要で，病理組織検査や局所細菌培養を行う必要がある．脊椎炎を生じる疾患として本症候群の可能性も念頭に置く必要があると思われる．

　The SAPHO syndrome is characterized by a combination of skin and musculoskeketal lesions, and spinal lesions are present in about 30％of the cases. We report the case of 53-year-old Japanese woman who complained of neck and low back pain caused by simultaneous cervical and lumbar spondylitis. Palmoplantar pustulosis and sternoclavicular hyperostosis were also present. Diagnosis was relatively easy because of the presence of these clinical manifestations. Bone scintigraphy showed increased activity in both lesions and was useful in detecting the extent of the disease. MRI showed inflammatory changes in both vertebral lesions. The diagnosis of SAPHO syndrome tends to be difficult when no skin lesions are detected or when atypical bone lesions are present. Bone biopsy or culture is necessary in such cases to rule out infectious osteomyelitis and malignant bone tumors. SAPHO syndrome should be borne in mind as one of the differential diagnoses of spondylitis.