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SAPHO syndrome is a rare clinical entity, an acronym named for its frequent coincident clinical manifestations, synovitis, acne, pustulosis, hyperostosis, and osteitis. Its clinical phenotype is widely heterogeneous, which coupled with its rarity causes many misdiagnoses. Herein, we present a case of a patient that was previously diagnosed with Paget’s disease. After an MVA, the full extent of his disease was detected via incidental imaging, which demonstrated sclerosis and ankylosis of the lumbar spine, sclerosis of the clavicles, and the pathognomonic bull’s head configuration on bone scan. Upon further questioning, the patient also harbored intermittent palmar pustulosis, psoriasis, sternoclavicular pain and tenderness, and widespread morning joint stiffness that ameliorates with activity. A high index of suspicion, and knowledge of its variable manifestations are paramount to arrive at a SAPHO diagnosis and thereby provide appropriate therapy to the patient.