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1
A 28-year-old man with Crohn’s disease in clinical remission developed palmoplantar pustules, acneiform eruptions, and acute chest pain after his sixth infliximab infusion.
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2
Chest MRI showed manubriosternal bone marrow oedema with mild adjacent soft-tissue inflammation, while cardiac investigations were normal.
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3
The patient met criteria for SAPHO syndrome, supported by axial osteitis, preceding palmoplantar pustulosis, and subsequent acneiform eruptions.
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4
A multidisciplinary team treated him with nonsteroidal anti-inflammatory drugs, methotrexate, and topical corticosteroids; chest pain resolved and skin lesions partially improved.
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5
Ustekinumab was considered, but infliximab was continued because of financial limitations and concern about a Crohn’s flare; intermittent topical corticosteroids treated the skin lesions.
