SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome includes a variety of inflammatory bone disorders associated with dermatologic pathology. Osteitis is the most prominent skeletal lesion as palmoplantar pustulosis and acne are the main skin lesions as well. A 57-year-old female presented with pustulosis on both hand which persisted several months. One month prior to this skin problem, she has been had lower back pain without trauma history for several months. On physical exam, tenderness on low back, left anterior chest wall pain were found, and slight claudication was observed. Radiologic studies including CT, MRI of spine, and PET-CT showed endplate lytic change on spine, focal hypermetabolic lesion in and around left rib, costochondral junction. These findings indicated the metastatic lesions in the bone. Bone biopsy was not done. Even though getting through complete medical checkups for identifying primary cancer, it has not been found yet and then is under observation on a regular basis without any treatments. Palmoplantar pustulosis has been treated with acitretin and topical steroids, and is well controlled. The osteitis of SAPHO syndrome presents usually as osteosclerosis. Our case showed multiple bony lytic lesions in imaging study implying metastasis. But there is no primary cancer now, so, herein, we suggest a rare case of SAPHO syndrome associated with bony lesions resembling bone metastasis.