isotretinoin and Osteomyelitis

For 12 years, a 26-year-old man had acne conglobata and a non-suppurative diffuse sclerosing osteomyelitis of the mandible as part of a chronic recurrent multifocal osteomyelitis of the sternum, the pelvic bones, and the femoral head, and aseptic arthritis of the knee, the fibulotalar, and the sternoclavicular joints. This fulfills the formal criteria of the SAPHO syndrome. Repeated surgical and antibiotic treatment combined with hyperbaric oxygen caused partial improvement. Complete relief and partial disappearance of the scintigraphic lesions was achieved with long-term corticosteroids, non-steroidal anti-inflammatory drugs, minocycline, and isotretinoin.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Inflammatory Agents; Dermatologic Agents; Drug Therapy, Combination; Humans; Isotretinoin; Male; Mandibular Diseases; Osteomyelitis; Prednisolone; Radionuclide Imaging

A 99mTc-MDP bone scan performed on a 34-yr-old female for suspected osteomyelitis of the proximal tibia revealed focally increased activity in both tibial tuberosities due to enthesopathies secondary to chronic isotretinoin therapy. Physicians should be aware that isotretinoin therapy can cause abnormal bone scans and not mistake these abnormalities for other diseases such as osteomyelitis. Second, bone scans may be helpful in diagnosing and following isotretinoin bone toxicity.

Topics: Adult; Diagnosis, Differential; Female; Humans; Hyperostosis; Isotretinoin; Knee Joint; Muscular Diseases; Osteomyelitis; Radionuclide Imaging; Spinal Diseases; Tendons