Mandibular osteomyelitis related to SAPHO syndrome following dental implant surgery: A case report

Chronic mandibular osteomyelitis is an intractable disease. There are some reports that it is related to the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. The etiology of the SAPHO syndrome is complex; it is likely to be the combined result of infectious, genetic, and immunologic factors. We present a case of mandibular osteomyelitis related to SAPHO syndrome that occurred after a dental implant surgery. A 56-year-old man presented at our hospital with the chief complaint of pain in the right lower jaw after dental implant treatment. We diagnosed bacterial osteomyelitis resulting from postoperative infection of the implant; his symptoms persisted despite antibacterial drug treatment and surgery. The patient also had a history of palmoplantar pustulosis and osteosclerosis of the collarbone. We diagnosed this patient with mandibular osteomyelitis related to the SAPHO syndrome. We initiated administration of 15 mg of prednisolone (PSL); however, the mandibular swelling could not be controlled with PSL alone. Thus, we initiated the administration of 5 mg of methotrexate and 15 mg of PSL, following which the cheek and jaw symptoms almost disappeared. The local bacterial infection and surgical stress in these patients with SAPHO syndrome may be related to the development of mandibular osteomyelitis. Thus, we do not recommend implant treatment for patients with the SAPHO syndrome.