case_images: PMC5447692_01
case_images: (A) Acne in right lower limb, which spread to patient's face, limbs, and trunk; (B, C) palmoplantar pustulosis.
case_images: btt-11-065Fig1.jpg
case_images: PMC5447692_01_btt-11-065Fig1.jpg
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case_images: After the fifth adalimumab shot, she visited our outpatient clinic with complaints of a tender shoulder and left clavicle and acne spreading over her trunk, limbs, and face (Figure 1A).
case_images: Computed tomography scan of clavicles. Erosion in right clavicle (white arrow).
case_images: btt-11-065Fig2.jpg
case_images: PMC5447692_01_btt-11-065Fig2.jpg
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case_images: C). She was referred to a rheumatologist in a tertiary hospital and received radiological examination, which supported the diagnosis of SAPHO syndrome. Computerized tomography showed bone erosions with edema in the bilateral sternoclavicular joints (Figure 2).
case_images: Bone-scintigraphy findings showed intensive uptake of 99mTc at the sternoclavicular joints and sternum, called a "bull's head" sign.
case_images: btt-11-065Fig3.jpg
case_images: PMC5447692_01_btt-11-065Fig3.jpg
case_images: f3-btt-11-065
case_images: Additionally, bone-scintigraphy findings showed extensive uptake of radiopharmaceutical 99mTc at the sternoclavicular joints and sternum, which is called a "bull's head" sign (Figure 3).