Summary of medical history

　The patient

a 41-year-old male

presented with pustules on the palms of both hands and plantar for 4 years

facial acne for 3 years

and sternoclavicular joint swelling and pain for 2 years. He has been misdiagnosed with pustular psoriasis

acne vulgaris

and osteomyelitis many times

and the effect of symptomatic treatment is not good

and the condition gradually worsens. External CT: insect-like bone destruction at the proximal end of the left clavicle

considering inflammatory disease. CRP is mildly elevated. The pustules on the palms of both hands

the soles of the feet

the erythema on the face

and the left sternoclavicular joint were swollen and painful

with a pain score of 8.

Traditional Chinese Medicine Diagnosis

　Bone Paralysis (Kidney Yang Deficiency

Xuanfu Yu Closure Syndrome)

Western medicine diagnoses

　SAPHO syndrome.

Interventions

　Skuticulizumab 300mg subcutaneous injection was given once a week. After 3 weeks of treatment

the patient was rechecked and found that the pustules on both palms and soles of both feet disappeared; the erythema and inflammatory papules on the face improved; the swelling of the left sternoclavicular joint became smaller and the pain decreased. The patient's systemic symptoms almost disappeared after 5 weeks of continuous medication

and the CRP was normalized in the follow-up examination. T

he treatment regimen was changed to stavudine 300mg subcutaneous injection once every 4 weeks. After 3 months of maintenance treatment

the drug was discontinued due to recurrent symptoms such as sore throat and upper respiratory tract infection. During the discontinuation period

the pustules on the palms of both hands and soles of both feet recurred. Dr. Song Ping

chief physician of the network consultation found that the patient's pustules on the palms of both hands were reddish

with a very small amount of pus. He was usually afraid of cold

his limbs were not warm

and his tongue was pale and his moss was thin and white. Tutor final diagnosis: pustular psoriasis (kidney yang deficiency

xuanfu depression closed evidence). The treatment was based on opening the Xuanfu

tonifying the kidney and detoxifying the toxin

and the tutor gave the self-created Kaixuan Kidney Tonic Formula: ephedra 10g

cinnamon 15g

Epimedium 30g

Morinda citrifolia 30g

Astragalus 30g

Radix Pseudostellariae 30g

Decocted with 9g of fine Xin

12g of Lianxiao

Poria 30g

Comfrey 10g

Comfrey 6g

and the patient didn't have upper respiratory tract infection after taking 14 doses of the formula. At the same time

the patient was treated with biological agents once every 4 weeks. The pustules on the palms of both hands and soles of both feet disappeared after 1 month of combined use of Chinese and western medicine. The maintenance dose of biological agent was changed to once every 8 weeks. After 16 weeks of oral Chinese medicine

the patient was not treated with biologics again.

Outcome of efficacy

　The pustules on the palms of both hands and soles of the feet disappear

the sternoclavicular joints become less swollen

and the pain is reduced. So far

there has been no recurrence of symptoms.