Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 5 2023 02 12 227 230 Firdevs Ulutaş Department of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey. Furkan Ufuk Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey. Aslı Bozdemir Department of Internal Medicine, Pamukkale University Faculty of Medicine, Denizli, Turkey. Veli Çobankara Department of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey. 2021 12 19 2022 05 08 A syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) is a rare autoimmune disease. It occurs in genetically predisposed individuals by immune activation triggered by possible infectious agents. A 60-year-old man was presented with musculoskeletal and cutaneous manifestations. After exclusion of differential diagnoses, he was diagnosed with SAPHO and successfully treated with adalimumab. He had a typical image defined as a bull’s head sign in bone scintigraphy with 99mTc- methylene diphosphonate. Positron emission tomography also revealed increased inflammatory activity in related anterior chest joints and soft tissue. We want to emphasize diagnostic radiological images in patients with SAPHO to increase the awareness of clinicians. https://crcp.tums.ac.ir/index.php/crcp/article/view/643