1
|
Mustfar SNS, Haroon R, Abd Aziz A. The Nomadic Bug: A Case Report of Salmonella Septic Arthritis of Sternoclavicular Joint in a Healthy Patient. Cureus 2024; 16:e57685. [PMID: 38707005 PMCID: PMC11070278 DOI: 10.7759/cureus.57685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
In an otherwise healthy adult, septic arthritis of the sternoclavicular joint is very uncommon. Usually, individuals with a history of intravenous drug usage or those with impaired immune systems are affected. The usual mode of spread is hematogenous spread or direct spread via neighbouring sources of infection. We report a rare case of mediastinitis and lung empyema preceded by sternoclavicular septic arthritis in an otherwise healthy 49-year-old woman due to Salmonella sp. Radiological imaging showed left sternoclavicular joint collection with bone destruction. The literature only contained reports of two prior occurrences of sternoclavicular joint septic arthritis caused by Salmonella. If diagnosed early, patients usually respond to medical treatment such as aspiration and antibiotics, as was the case with our patient.
Collapse
Affiliation(s)
| | - Raihanah Haroon
- Radiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Azian Abd Aziz
- Radiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| |
Collapse
|
2
|
Macedo MB, Pereira RMR. Shouldering the Pain: Septic Sternoclavicular Arthritis Following Pericardiostomy in a Systemic Lupus Erythematosus Patient. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2021.94557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
3
|
Reid R, McKnight RR, Secrist E, Clark C. Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00024. [PMID: 34264874 DOI: 10.2106/jbjs.cc.20.00690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old boy presented with 3 weeks of atraumatic left-sided sternoclavicular (SC) joint pain, swelling, and decreased range of motion. After imaging and laboratory workup, he underwent operative irrigation, debridement, and antibiotic therapy with complete resolution of his symptoms. Surgical cultures were consistent with SC septic arthritis. CONCLUSION The management of septic arthritis in pediatric patients remains varied. Here, we present the only report of SC septic arthritis due to Cutibacterium acnes in a healthy pediatric patient. Given the similar clinical findings of pain and swelling to affected bones and joints, differentiating SC septic arthritis from other conditions within the clinical spectrum of chronic nonbacterial osteomyelitis remains challenging. Clinicians should maintain a high index of suspicion when patients present with pain and swelling over the SC joint.
Collapse
Affiliation(s)
- Risa Reid
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Eric Secrist
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Christian Clark
- Orthocarolina Pediatric Orthopaedic Center, Charlotte, North Carolina
| |
Collapse
|
4
|
Abstract
RATIONALE Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION She was treated with 6 weeks of antibiotic therapy. OUTCOMES After antibiotic treatment, she was successfully treated without recurrence. LESSONS Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
Collapse
|
5
|
Tasnim S, Shirafkan A, Okereke I. Diagnosis and management of sternoclavicular joint infections: a literature review. J Thorac Dis 2020; 12:4418-4426. [PMID: 32944355 PMCID: PMC7475584 DOI: 10.21037/jtd-20-761] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.
Collapse
Affiliation(s)
- Sadia Tasnim
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
6
|
Agarwal P, Agarwal N, Hansberry DR, Majmundar N, Goldstein IM. Sternoclavicular joint arthropathy mimicking radiculopathy in a patient with concurrent C4-5 disc herniation. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Youssef D, Bhargava A. Escherichia coli bacteremia with secondary seeding in the sternoclavicular joint: A case report and literature review. Germs 2019; 9:43-46. [PMID: 31119116 DOI: 10.18683/germs.2019.1156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/02/2018] [Accepted: 12/28/2018] [Indexed: 11/08/2022]
Abstract
Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a rare phenomenon in healthy individuals. It is generally described in patients with predisposing risk factors such as diabetes mellitus, intravenous drug use, immunosuppression, chronic liver disease and central venous catheters. Case report We describe a case of Escherichia coli related SCJ septic arthritis in an otherwise healthy adult with review of the literature. Discussion There were only two previous reports of patients with E. coli and to our knowledge, this is the third case of a patient with SCJ septic arthritis secondary to E. coli without predisposing factors. A review of literature on SCJ septic arthritis among otherwise healthy adults showed that pain and redness of the SCJ are the most common presentation symptoms, with Staphylococcus aureus being the most common causative organism. More than half of these patients required surgical intervention for associated complications, but all patients had complete recovery with appropriate treatment with no reported mortality. Conclusions SCJ infection is rare and has a significant morbidity. It should be identified and treated properly to avoid the development of complications. Imaging studies are used to assist in making the diagnosis, and culture results help to identify the pathogen.
Collapse
Affiliation(s)
- Dima Youssef
- MD, Division of Infectious Disease, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, Detroit, MI 48236, USA
| | - Ashish Bhargava
- MD, Wayne State University, School of Medicine, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, Detroit, MI 48236, USA
| |
Collapse
|
8
|
Masmoudi K, Elleuch E, Akrout R, Feki A, Ezzeddine M, Fourati H, Lahiani D, Ben Jemaâ M, Baklouti S. Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report. J Med Case Rep 2018; 12:205. [PMID: 29973288 PMCID: PMC6033282 DOI: 10.1186/s13256-018-1709-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Septic arthritis is an infectious disease that commonly affects weight-bearing or proximal joints such as the knee and the hip. The sternoclavicular joint is an unusual site of this entity. It usually occurs in patients with diabetes mellitus, intravenous drug abusers, or those with rheumatoid arthritis. Analysis of the previous literature showed few articles and these described essentially cases of unilateral presentation. CASE PRESENTATION We report a rare case of a bilateral septic arthritis of the sternoclavicular joint sustained by a 71-year-old Tunisian woman whose medical history was significant for methicillin-resistant Staphylococcus aureus infective endocarditis 6 months ago. Imaging investigations revealed destruction of the medial extremities of her two clavicles and bilateral collections in the soft tissues around her sternoclavicular joints. She was treated successfully by needle aspiration drainage combined with a 12-week antibiotherapy. CONCLUSIONS Bilateral septic arthritis of the sternoclavicular joint is an extremely rare entity, with a paucity of literature. Only early diagnosis, which is obtained from the culture of the joint fluid using needle aspiration, allows satisfactory functional outcome and a good prognosis. Osteoarticular infections should be considered in patients with recent infective endocarditis in cases of fever recurrence.
Collapse
Affiliation(s)
- Karim Masmoudi
- Medicine Faculty of Sousse, Mohamed Karoui Avenue, zip code 4000, Sousse, Tunisia.
| | - Emna Elleuch
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Rim Akrout
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Afef Feki
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Mariam Ezzeddine
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Hela Fourati
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Dorra Lahiani
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Mounir Ben Jemaâ
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Sofiène Baklouti
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| |
Collapse
|
9
|
S. aureus pneumonia and sternoclavicular septic arthritis: An unusual complication. Arch Bronconeumol 2017; 54:168-169. [PMID: 29108760 DOI: 10.1016/j.arbres.2017.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/19/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
|
10
|
Masuzawa K, Asakura T, Ishii M, Yasuda H, Sugiura H, Betsuyaku T. Sternoclavicular joint osteomyelitis extending to lung abscess complicated by Staphylococcal infective endocarditis. IDCases 2017; 9:36-37. [PMID: 28660126 PMCID: PMC5479943 DOI: 10.1016/j.idcr.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 11/19/2022] Open
|
11
|
Amao-Ruiz E, Correa-Fernandez AM, de la Fuente Galán L. Serratia marcescens septic sternoclavicular joint arthritis: A case report. REUMATOLOGIA CLINICA 2016; 12:238-239. [PMID: 26725022 DOI: 10.1016/j.reuma.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/17/2015] [Accepted: 10/23/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Elvis Amao-Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Ana María Correa-Fernandez
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luis de la Fuente Galán
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología Hospital Clínico Universitario de Valladolid, Valladolid, España
| |
Collapse
|
12
|
|
13
|
Treatment of sternoclavicular joint osteomyelitis with debridement and delayed resection with muscle flap coverage improves outcomes. Surg Res Pract 2014; 2014:747315. [PMID: 25379557 PMCID: PMC4208504 DOI: 10.1155/2014/747315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis.
Collapse
|
14
|
Das AK, Monga P. Septic arthritis of the sterno-clavicular joint as a cause of dysphagia: a report of two cases and review of literature. Clin Rheumatol 2013; 33:141-3. [PMID: 24249147 DOI: 10.1007/s10067-013-2437-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
Abstract
Septic arthritis of sterno-clavicular joint is a rare entity which is often associated with predisposing conditions like intravenous drug abuse and diabetes. Its prevalence in healthy subjects with absence of medical co-morbidities has been sporadically reported. Due to the rarity of the condition, diagnosis is often delayed predisposing the patients to serious complications. Clinical suspicion supported by haematological and radiological investigations is needed for early diagnosis. Dysphagia as a complication of sterno-clavicular joint infection has not been reported. In this study, we report a case of sterno-clavicular joint infection causing dysphagia and review the literature with regards to aetiology, predisposing factors and treatment options. The aim of this study is to highlight the importance of early diagnosis in suspected cases of septic arthritis of sterno-clavicular joint and institution of intravenous antibiotics.
Collapse
Affiliation(s)
- Abhishek Kumar Das
- Department of Trauma and Orthopaedics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire, UK,
| | | |
Collapse
|
15
|
Doyle MP, Jennings SB, Horton MDA. Delayed surgical intervention of sternoclavicular joint infection with increased complications. ANZ J Surg 2013; 85:193-5. [PMID: 24164960 DOI: 10.1111/ans.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mathew P Doyle
- Cardiothoracic Surgery, St George Hospital, Kogarah, New South Wales, Australia
| | | | | |
Collapse
|
16
|
Spontaneous septic arthritis in a patient without trauma, coinfection, or immunosuppression. Am J Emerg Med 2013; 31:1623.e3-4. [PMID: 24060330 DOI: 10.1016/j.ajem.2013.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/22/2013] [Indexed: 11/24/2022] Open
Abstract
Septic arthritis is a rare infection, most often affecting the knee and hip [1]. Infections are often secondary to joint repair or replacement surgery, systemic infection, or intravenous recreational drug use [1,2].Diabetes, rheumatoid arthritis, hepatic dysfunction, and immunosuppression are common risk factors [1,2]. Although septic arthritis can occur spontaneously, such occurrences are rare. We report a case of a previously healthy 54-year-old woman with no known risk factors presenting to a freestanding emergency department with 5 days of shoulder pain.
Collapse
|
17
|
|
18
|
Kaewpoowat Q, Prasidthrathsint K, Permpalung N, Suksaranjit P, Bischof E. Mysterious neck pain. Am J Emerg Med 2012; 31:466.e1-2. [PMID: 23158598 DOI: 10.1016/j.ajem.2012.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022] Open
|
19
|
Sternoclavicular joint infection: classification of resection defects and reconstructive algorithm. Arch Plast Surg 2012; 39:643-8. [PMID: 23233891 PMCID: PMC3518009 DOI: 10.5999/aps.2012.39.6.643] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/10/2012] [Accepted: 07/17/2012] [Indexed: 12/02/2022] Open
Abstract
Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past 90°. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.
Collapse
|
20
|
A case of strenoclavicular septic arthritis with mediastinitis managed conservatively and literature review. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
21
|
Shioya N, Ishibe Y, Kan S, Masuda T, Matsumoto N, Takahashi G, Makabe H, Yamada Y, Endo S. Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report. BMC Emerg Med 2012; 12:7. [PMID: 22702399 PMCID: PMC3447652 DOI: 10.1186/1471-227x-12-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 05/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Septic arthritis of the sternoclavicular joint (SCJ) is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes. CASE PRESENTATION A 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2 weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain. CONCLUSION Diabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.
Collapse
Affiliation(s)
- Nobuki Shioya
- Department of Critical Care and Emergency, Iwate Medical University, Morioka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Chest wall abscess may occur as primary infection or secondary to open trauma or thoracic wall surgery. The authors describe an unusual case of Escherichia coli costochondritis occurring 2 months after a blunt chest wall trauma. Primary chest wall abscess due to E coli costochondritis has been previously reported only twice occurring after urinary tract infection. All other very few reports of E coli costochondritis have been reported only after thoracic surgical procedures. An English literature review of primary chest wall abscess showed that 4 pathogens are responsible for the majority of cases: Actinomyces, Staphylococcus aureus, Candida albicans and Salmonella. C albicans costochondritis was most commonly reported among heroin addicts. The appearance of a growing chest wall mass should always prompt a search for an infectious cause, even with little or no systemic signs and symptoms.
Collapse
|
23
|
Puri V, Meyers BF, Kreisel D, Patterson GA, Crabtree TD, Battafarano RJ, Krupnick AS. Sternoclavicular joint infection: a comparison of two surgical approaches. Ann Thorac Surg 2011; 91:257-61. [PMID: 21172525 DOI: 10.1016/j.athoracsur.2010.07.112] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study compares conventional open debridement with the recently proposed flap closure technique for sternoclavicular joint infection. METHODS This is a retrospective review of patients undergoing surgery for sternoclavicular joint infection during the last 7 years. RESULTS Twenty patients underwent 35 operations for sternoclavicular joint infection from 2002 to 2009. The debridement and open wound procedure (10 of 20 patients, 50%) involved debridement of the clavicle, manubrium, and first rib and open wound care. The joint resection and flap closure procedure (10 of 20 patients, 50%) involved partial resection of the clavicle, manubrium, and first rib, with immediate (9 of 10) or early (1 of 10) wound closure with pectoralis major advancement flap. The two groups were comparable in comorbidities, duration of symptoms, radiologic findings, and microbiologic results. Despite an approach of planned reoperation for wound care, the open group had fewer mean procedures performed per patient (1.6±0.7 versus 1.9±1.6), owing to fewer unplanned procedures (0 versus 0.8 procedures/patient) than the flap group. The incidence of wound complications (hematoma, seroma) was lower in open patients (0 of 10 versus 5 of 10). The median length of hospitalization was shorter in the open group (5.5 versus 10.5 days), but all open patients (10 of 10; 100%) required prolonged wound care compared with 2 of 10 (20%) in the flap group. The only hospital mortality occurred in the flap group. Eventual wound healing was satisfactory in all survivors. CONCLUSIONS For sternoclavicular joint infection, a single-stage resection and muscle advancement flap leads to a higher incidence of complications. Debridement with open wound care provides satisfactory outcomes with minimal perioperative complications but requires prolonged wound care.
Collapse
Affiliation(s)
- Varun Puri
- Division of Cardiothoracic Surgery, Washington University, Barnes Jewish Hospital, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Nusselt T, Klinger HM, Freche S, Schultz W, Baums MH. Surgical management of sternoclavicular septic arthritis. Arch Orthop Trauma Surg 2011; 131:319-23. [PMID: 20721567 PMCID: PMC3040322 DOI: 10.1007/s00402-010-1178-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition and has many diagnostic and therapeutic standards. The purpose of this study was to evaluate our experience with surgical and diagnostic management to provide a surgical pathway to help surgeons treat this disease. METHOD We retrospectively reviewed five patients who were managed surgically between 1999 and 2007. All patients underwent structured diagnostic and treatment protocols. The functional outcome was evaluated using the Constant Score. PATIENTS The patients had the following underlying medical conditions: laryngeal cancer, port-explantation linked to a rectum carcinoma, spondylodiscitis, and brain stem infarct with reduced general condition; one patient had no underlying medical problems. Three patients underwent a simple incision, debridement and drainage, and two patients underwent an extended intervention with partial resection of the sternoclavicular joint. The mean duration of follow-up was 29 months (range 24-36 months). All patients had well-healed wounds without signs of reinfection. The Constant Score for the functional outcome at the time of the last follow-up was 76 points (range 67-93 points). All patients recovered completely from SCJ disease. CONCLUSION Our recommendations for the management of septic arthritis of the sternoclavicular joint include standard treatment steps and assessments. The early stages of infection can be managed by simple incision, debridement and drainage. In advanced stages of infection, a more radical intervention is preferable.
Collapse
Affiliation(s)
- Thomas Nusselt
- Department of Orthopaedic Surgery, University of Goettingen Medical Centre (UMG), Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | | | | | | | | |
Collapse
|