Abstract
Synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic nonbacterial osteomyelitis (CNO) represent overlapping osteoarticular autoinflammatory syndromes, with a minority displaying neutrophilic skin features at the time of diagnosis. The pathophysiological link and chronological timeframe between skin and osteoarticular findings remain ambiguous, which in turn can manifest in diagnostic delay. We present a rare pediatric case of SAPHO-CNO with a clear association between cutaneous and osteoarticular symptoms, treated with nonsteroidal anti-inflammatory medications, corticosteroids, and intravenous pamidronate. By raising physician awareness of these syndromes, we hope that appropriate management will be initiated in a more timely fashion avoiding unnecessary investigations and treatment.