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A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome complicated by IgA nephropathy with nephrotic syndrome

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Abstract

A 62-year-old man visited our hospital with a mild sore throat, high-grade fever, and clavicular pain. Seven years earlier, he had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. His clavicles were tender and remarkably swollen. Also noted was marked pitting edema in the lower extremities and pustulosis on the palms and soles of the feet. Laboratory studies on admission showed an elevated white cell count (23,400/μl) and serum C-reactive protein level (24.4 mg/dl). Urinalysis revealed proteinuria (2+) and occult blood (3+) with numerous dysmorphic red blood cells and hyalin casts. The patient was diagnosed with recurrence of his SAPHO syndrome and started on oral glucocorticoid therapy. By day 9 after admission, he had gained 16 kg in body weight, and his proteinuria (6.4 g/day) and serum creatinine level (2.3 mg/dl) were elevated. Renal biopsy revealed mesangial proliferative glomerulonephritis with deposition of IgA and C3 in the mesangial area and along the capillary walls. The patient was diagnosed with IgA nephropathy accompanied by nephrotic syndrome. With oral prednisolone therapy, his fever, clavicular pain, and proteinuria were gradually relieved. The clinical course in this case suggests the onset of nephrotic syndrome with IgA nephropathy was associated with the recurrence of the patient’s SAPHO. To our knowledge, this is the first reported case of SAPHO-associated IgA nephropathy.

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Conflict of interest

The authors declare that no conflict of interest exists.

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Authors and Affiliations

  1. Department of Internal Medicine, Uda Municipal Hospital, Uda, Japan

    Katsuhiko Morimoto, Osamu Asai, Kuniko Mondori & Hideo Shiiki

  2. Department of Orthopedics, Uda Municipal Hospital, Uda, Japan

    Kiyonori Tomiwa, Takamitsu Mondori & Yoshiyuki Nakagawa

  3. First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Katsuhiko Morimoto, Kimihiko Nakatani & Masayuki Iwano

  4. Department of Nephrology, Kyoto Yamashiro General Medical Center, Kizugawa, Japan

    Kimihiko Nakatani & Osamu Asai

  5. Division of Nephrology and Clinical Laboratories, Faculty of Medical Science, University of Fukui, Yoshida, Japan

    Masayuki Iwano

Authors
  1. Katsuhiko Morimoto
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Correspondence to Kimihiko Nakatani.

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Morimoto, K., Nakatani, K., Asai, O. et al. A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome complicated by IgA nephropathy with nephrotic syndrome. CEN Case Rep 5, 26–30 (2016). https://doi.org/10.1007/s13730-015-0184-z

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  • DOI: https://doi.org/10.1007/s13730-015-0184-z

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