Author(s)
Asad A. Haider, BA
Nathan R. Lindquist, MD BS
Ann M. Gillenwater, MD
Affiliation(s)
McGovern Medical School at the University of Texas Health Sciences Center in Houston;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to explain why bacterial infections may mimic the presentation of tumors and discuss the extensive differential diagnosis of an expansile neck mass. Objectives: Herein, we present a case of synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome with suspicious bony destruction and diffuse involvement of soft tissue of the neck presenting to our quaternary cancer referral center. Study Design: Case report. Methods: A review of the patient's medical history along with a literature search on SAPHO syndrome was performed to gather information for this case report. Results: A 23 year old male presented with a rapidly expansile mass and swelling of the right clavicle with bony involvement from the surrounding soft tissues of the neck. Fine needle aspiration (FNA) was indeterminate, while imaging demonstrated a right supraclavicular 3.9 cm avascular lesion. Given the high suspicion for malignant process, the patient was referred to our institution for definitive tissue sampling and treatment. Operative cultures yielded only propionibacterium acnes (P acnes), while tissue cultures were negative for malignancy but did suggest likely osteomyelitis. As a result, the patient was diagnosed with atypical SAPHO syndrome. The patient's disease was treated with clindamycin with no signs of recurrence on one month followup. Conclusions: SAPHO syndrome in the head and neck may present as a rapidly growing neck mass with bony invasion. While malignant processes may lead the differential diagnosis, SAPHO syndrome should be considered when tissue sampling and cultures are consistent with a bacterial infection due to P acnes.