Abstract: Objective SAPHO syndrome is a clinically rare autoimmune disease. Grasp the clinical manifestations and imaging features of the disease，and combine the review of related articles with improving the understanding of the disease and the accuracy of diagnosis. Methods One SAPHO syndrome patient with ″low back pain″ as the primary manifestation and atypical skin changes was analyzed and treated，combined with the relevant literature review，and the clinical characteristics were summarized. Results The primary manifestation of the patient was ″low back pain with pain in both lower limbs″ with atypical skin lesions. The check results showed the erythrocyte sedimentation rate，C-reactive protein，complement C3，and complement C4 increased，and the anti-histone antibody is weakly positive. Chest CT showed sternal rib clavicular hypertrophy syndrome. Whole-body bone scan（ECT） showed abnormal active bone metabolism foci on both sides of the clavicle and sternum，considering the possibility of SAPHO syndrome. Conclusion The clinical manifestations of SAPHO syndrome lack specificity， and its diagnosis should be based on clinical manifestations， past medical history， and imaging examinations. The diagnosis of the disease by whole-body bone scan（ECT）is specific.

Key words: SAPHO syndrome, acne, osteitis, synovitis, low back pain, atypical skin lesions