A case of axial spondyloarthritis acute onset as opportunity tonsil foci infection

:   A 49-year-old female with a chief complaints of arthralgia, and a medical history is Hashimoto's disease presented to us. She had been previously treated for Sjogren's syndrome at our hospital. She had anterior chest and polyarticular pain. On admission, her blood test results were as follows: white blood cells, 12700/μl; C reactive protein, 24.8 mg/dl; erythrocyte sedimentation rate 122 mm/h, Anti-streptolysin O, 1179 IU/ml;an, ASK, 10240. She had tenderness in both her hand and finger joints, recurrent episodes of tonsillitis and pustular eruption. Her imaging studies were remarkable for inflammation of the sacroiliac joint and bone erosion of the hand joint, among other findings. We considered a diagnosis of either axial spondyloarthritis or synovitis acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome due to an opportunistic tonsillar infection. The differential diagnosis between axial spondyloarthritis or SAPHO syndrome is difficult to make. We discuss this case in the context of previous literature.