Case Report: A Teen with Acne and Chest Pain

A 15-year-old male with a body mass index of 38 presented to Sirada Panupattanapong, MD, in Cleveland Clinic’s Center for Pediatric Rheumatology and Immunology, with a two month history of persistent chest pain. It had progressed to his neck and back and worsened with any body movement. Prior to his consult, a battery of cardiac and pulmonary tests had all proved negative.

His chest wall exam was normal, but he mentioned a years-long history of severe, refractory body acne, consistent with nodulocystic acne and hidradenitis suppurativa. His bloodwork showed systemic inflammation, and magnetic resonance imaging of the chest wall and spine revealed multiple areas of contrast enhancement in the sternum, multiple costovertebral joints and multiple vertebrae, findings consistent with osteitis.

Watch the short case report below to reveal the diagnosis and treatment of a very rare inflammatory condition in children.

A 15-year-old male with a body mass index of 38 presented to Sirada Panupattanapong, MD, in Cleveland Clinic’s Center for Pediatric Rheumatology and Immunology, with a two-month history of persistent chest pain. The pain had progressed to his neck and back and worsened with any body movement. Prior to his consult, a battery of cardiac and pulmonary tests – cardiac enzymes, echocardiogram, electrocardiogram and chest computed tomography – had all proved normal.

His chest wall exam was normal, but he mentioned a years-long history of severe, refractory body acne that presented on his back, chest wall and groin, consistent with nodulocystic acne and hidradenitis suppurativa. His bloodwork showed systemic inflammation, with leukocytosis, neutrophil predominance and markedly elevated erythrocyte sedimentation rate (ESR). Magnetic resonance imaging (MRI) of the chest wall and spine revealed multiple areas of contrast enhancement in the sternum, multiple costovertebral joints and multiple vertebrae, findings consistent with osteitis.

Watch the short case report below to reveal the diagnosis and treatment of a very rare inflammatory condition in children.

As Dr. Panupattanapong reveals in the video, the patient was diagnosed with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, characterized by the conditions in the acronymic name. It is also known as sternocostoclavicular hyperostosis, acne-associated spondyloarthropathy and pustulotic arthro-osteitis. Though SAPHO syndrome is not well understood, researchers and clinicians speculate that a number of genetic factors, environmental or infectious factrsHe was started on idalimumab and methotrexate with a remarkable response. His follow-up MRI at 18 months showed resolution of the osteitis and marked improvement in his acne and inflammatory markers.
“This case highlights the reality of suffering and the [need for] awareness of this condition in children that present with chest or joint pain,” says Dr. Panupattanapong.