Case Report: Sapho syndrome complicated by chest pain successfully treated with relocation.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic autoinflammatory disease characterized primarily by cutaneous manifestations and osteoarticular involvement, and remains challenging to treat. Its pathogenesis is not fully understood and may involve genetic, immunological and environmental factors. Environmental factors play a significant role in autoimmune diseases such as asthma, urticaria, and rheumatic heart disease. Avoiding repeated exposure to sensitizing environmental trigger (e.g., microorganism or allergens) shows considerable potential in the treatment of above immune mediated disorders. This article reports a case of a 60-year-old female admitted with recurrent chest pain for over two months accompanied by periodic plantar pustules. A diagnosis of SAPHO syndrome was made based on her medical history, clinical manifestations, and bull's head sign on bone scintigraphy findings, after excluding other potential causes. Notably, the patient's husband had ankylosing spondylitis, and neither the patient nor her husband had a family history of inherited immune diseases. This rare occurrence in cohabiting spouse suggests that they shared environmental exposures may contribute to the development of phenotypically overlapping immune diseases. Therefore, we advised her to try changing her residential environment (moving to a drier, better ventilated environment) and iodophor disinfection of soles. Subsequently, her plantar pustules and chest pain were significantly relieved and remained relapse free. We first reported a case of successful environmental modification as an adjunctive treatment for SAPHO syndrome, suggesting a potential role of environmental factors in pathogenesis and clinical management of this condition.