Ocular presentation of the SAPHO syndrome

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a seronegative spondylarthropathy. The term, introduced in 1987, describes a syndrome with various previous pseudonyms: multifocal recurrent osteomyelitis; arthritis with acne; and osteitis with pustulosis palmaris and plantaritis.1 Skeletal changes are commonest in the chest wall and skull involvement is uncommon.2,3 We present an unusual case of orbital SAPHO syndrome. An 18 year old woman presented with 5 months’ retrobulbar pain, 2 weeks’ decreased vision, and a protruding appearance of her left eye. Previous medical history included thoracic spinal osteomyelitis aged 7. Her grandfather had suffered from a multifocal, recurrent osteomyelitis. Visual acuity (VA) was 6/6 right eye and 6/9 left eye. There was 3 mm left axial proptosis with restricted elevation. Pupil reactions, colour vision, …