一乳癌病患合併之SAPHO症候群以pamidronate成功治療之病例報告

SAPHO syndrome in a patient with breast cancer, successfully treated with pamidronate

SAPHO（synovitis, acne, pustulosis, hypcrostosis與osteitis）症候群，為少見之疾病。本篇病例報告描述一位38歲女性於34歲時因左側乳房硬塊，診斷為初期乳癌，接受手術完全切除治療。病患於術後三個月，開始出現持續性右側胸鎖骨關節腫痛與間歇性下背痛的症狀。接下來的一年內，陸續發展出左側胸鎖骨關節與右側薦腸關節疼痛，影響生活甚劇。其間屢次追蹤核子掃描，乳房與腹部超因波，與腫瘤標記（CA153），皆無乳癌復發與全身其他部位轉移的現象。以非類固醇消炎藥與止痛藥症狀治療，僅能減輕部份疼痛。術後第三年，病患手腳開始出現紅疹與膿疱，配合當時X光與電腦斷層楚顯示右側胸鎖骨關節骨質增生（hypcrostosis），右側薦腸關節炎，與多發性腰椎椎骨炎，確立SAPHO症候群之治斷。在加上sulfasalazine治療兩個月無效後，給予pamidronate 90毫克靜注治療。一個月內骨關節疼痛症狀逐漸獲得緩解，至今滿一年未再復發。本病例提供SAPHO症候群可能與乳癌相關，與pamidronate可有效治療SAPHO症候群之臨床經驗。

We report a 39-year-old woman who was diagnosed to be invasive ductal carcinoma of left breast, TINOMO, and received modified radical mastectomy and axillary lymph node dissection at the age of 34. She developed constant pain and swelling over right sternoclavicular joint and intermittent low back pain 3 months after the surgery, and subsequent right sacroiliac joint and left sternoclavicular pain over the next 1 year. The serial bone scans revealed additive signals over right then left sternoclavicular joint, right sacroiliac joint, and right lateral border of L5 vertebral body, which was never compatible with bony metastasis. No evidence of metastasis or infection was demonstrable elsewhere. In the third year of fluctuating bone pain, she developed painless pustules over bilateral palms and soles. Together with the established characteristic hyperostosis of right sternoclavicular joint, osteitis over lumbar vertebrae and unilateral sacroilitis of right side, the diagnosis of SAPHO syndrome was deduced. Sulfasalazine was added on to the long-term NSAIDs and analgesic therapies but was not successful. Then pan1idronate disodium 90 mg intravenous injection was given. The infusion was well tolerated. Her pain relieved and mobility improved gradually within one month. Up to now, she has remained symptom free for more than 1 year. This case suggests that SAPHO syndrome may be associated with breast cancer and supports that pamidronate is very effective in treating SAPHO syndrome.