Reversible rib photopenia demonstrated by bone scan in vaso-occlusive complication of systemic lupus erythematosus.

We report the case of a 39-year-old woman with systemic lupus erythematosus (SLE), who was seen for excruciating rib pain, thrombocytopenia, anemia, renal failure, and an inflammatory syndrome. She was treated with high-dose steroids. A bone scan performed initially revealed upper thoracic cage photopenia and was suggestive of a vaso-occlusive crisis. At the same time, thrombophlebitis of the right arm was diagnosed. The presence of a lupus anticoagulant was highlighted. Plasmapheresis initiated 5 days after the bone scan relieved the patient immediately. A follow-up bone scan performed 20 days after the initial study showed improvement in uptake of the upper anterior ribs and confirmed the diagnosis of vaso-occlusive crisis.