The combination of synovitis, acne, pustulosis, hyperostosis and aseptic osteitis is known as SAPHO syndrome. Osteitis involves the anterior chest, particularly the sternoclavicular and upper costosternal junctions. Diagnosis is difficult when there are no typical skin and bone lesions and differential diagnosis includes bacterial ostomyelitis, malignancy and Paget's disease. We present a case of SAPHO syndrome with aseptic femoral osteitis and symmetrical involvement of the lower costosternal junctions. The main advantage of recognition and diagnosis of SAPHO syndrome is the avoidance of unnecessary prolonged antibiotic treatment and repeated invasive procedures.