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Alnasser A, Alamari ZS, Almutairi TM, Aljohani HT, Almulla AM. Sternoclavicular Septic Arthritis and Surgical Intervention: A Case Report. Cureus 2024; 16:e53002. [PMID: 38406090 PMCID: PMC10894666 DOI: 10.7759/cureus.53002] [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: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Management of septic arthritis is an area of controversy, especially in rare locations like the sternoclavicular joints. In this case report, we present a case of septic sternoclavicular joint, which was resistant to medical treatment and deteriorated during the treatment course. Although medical treatment has proven effective based on previous literature, some cases will still not benefit from it. In this case, our patient responded significantly to surgical treatment regarding upper limb function, faster infection eradication and rehabilitation, and shorter hospitalization and antibiotics duration.
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Affiliation(s)
- Abdullah Alnasser
- Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Zeyad S Alamari
- Orthopaedics, Prince Sultan Military Medical City, Riyadh, SAU
| | - Taif M Almutairi
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Hamid T Aljohani
- Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Ahmed M Almulla
- Orthopaedics and Traumatology, Prince Sultan Military Medical City, Riyadh, SAU
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Pinto JF, Schmitt W. Septic arthritis of the sternoclavicular joint in a patient with human immunodeficiency virus infection. Clin Case Rep 2021; 9:e05226. [PMID: 34950480 PMCID: PMC8673165 DOI: 10.1002/ccr3.5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/21/2021] [Accepted: 12/04/2021] [Indexed: 11/12/2022] Open
Abstract
Septic arthritis is an unusual manifestation in patients with human immunodeficiency virus (HIV). The sternoclavicular joint is rarely affected, although it should be considered in immunosuppressed patients and users of intravenous drugs. Staphylococcus aureus is the most common pathogen detected and should be covered by empiric antibiotic therapy.
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Affiliation(s)
- Joana F. Pinto
- Radiology DepartmentUniversity Hospital Center of PortoPortoPortugal
| | - Willian Schmitt
- Radiology DepartmentUniversity Hospital Center of PortoPortoPortugal
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Guillen Astete CA, Garcia Garcia V, Luque Alarcon M. Relevance of a normal ultrasound study in patients with non-traumatic acute shoulder pain. REUMATOLOGIA CLINICA 2020; 16:509-510. [PMID: 30704920 DOI: 10.1016/j.reuma.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - Monica Luque Alarcon
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Madrid, España
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Bayfield NGR, Wang E, Larbalestier R. Medical and conservative surgical management of bacterial sternoclavicular joint septic arthritis: a case series. ANZ J Surg 2020; 90:1754-1759. [DOI: 10.1111/ans.16019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas G. R. Bayfield
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
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Kang BS, Shim HS, Kwon WJ, Lim S, Park GM, Lee TY, Bang M. MRI findings for unilateral sternoclavicular arthritis: differentiation between infectious arthritis and spondyloarthritis. Skeletal Radiol 2019; 48:259-266. [PMID: 29978244 DOI: 10.1007/s00256-018-3023-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze and identify magnetic resonance imaging (MRI) and clinical findings for the differentiation between infectious arthritis and spondyloarthritis in patients with unilateral sternoclavicular arthritis. MATERIALS AND METHODS We retrospectively collected and evaluated the magnetic resonance (MR) images of 21 patients diagnosed with unilateral sternoclavicular arthritis, including 12 with infection and nine with spondyloarthritis, between 2004 and 2017. Capsular distension, extracapsular fluid collection, periarticular muscle edema, the prevalence and distribution of bone marrow edema, and the prevalence and size of bone erosions were assessed on the MR images. Clinical data were also reviewed. RESULTS Capsular distension was more prominent in patients with infectious arthritis than those with spondyloarthritis (p = 0.002); extracapsular fluid collection and periarticular muscle edema were also more common in infectious arthritis than spondyloarthritis (p < 0.001, respectively); moreover, bone erosions were larger in infectious arthritis than spondyloarthritis (p = 0.023). Other findings significantly associated with infectious arthritis included advanced age (p = 0.007), an elevated C-reactive protein (CRP) level (p = 0.001), and erythrocyte sedimentation rate (ESR) (p < 0.001). The prevalence and distribution of bone marrow edema and the prevalence of bone erosions on MRI, the white blood cell count, and sex showed no significant differences between the two groups. CONCLUSIONS Capsular distension, extracapsular fluid collection, periarticular muscle edema, and the size of bone erosions on MRI, as well as the age, CRP level, and ESR of patients, could be helpful for differentiating infectious arthritis from spondyloarthritis involving the sternoclavicular joint.
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Affiliation(s)
- Byeong Seong Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea.
| | - Hyun Seok Shim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Woon Jung Kwon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Soyeoun Lim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Gyeong Min Park
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Tae Young Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Minseo Bang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
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Richardson A, Tewelde SZ, Dezman ZDW. 48-year-old Man with Fevers, Chest Pain, and a History of Substance Abuse. Clin Pract Cases Emerg Med 2018; 2:297-299. [PMID: 30443610 PMCID: PMC6230364 DOI: 10.5811/cpcem.2018.8.39252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022] Open
Abstract
A 48-year-old male with a history of intravenous (IV) drug use presented to the emergency department (ED) for an area of mild pain and erythema on his chest. He was then triaged to the urgent care, or fast track, area of the ED. He was well appearing with normal lab findings and vital signs, but his workup revealed mediastinitis with osteomyelitis of the manubrium and clavicles, a surgical emergency. His treatment course included IV antibiotics and operative intervention with thoracic surgery. The patient looked too good to be sick, yet he had a life-threatening infection.
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Affiliation(s)
- Adam Richardson
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Semhar Z Tewelde
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Zachary D W Dezman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Saad Aldin E, Sekar P, Saad Eddin Z, Keller J, Pollard J. Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens. IDCases 2018; 12:44-46. [PMID: 29942746 PMCID: PMC6010954 DOI: 10.1016/j.idcr.2018.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
An 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of antimicrobials. No fevers were documented. During the admission an 18F-FDG PET/CT was performed in continuation of his sarcoma staging workup. This revealed unexpected abnormal radiotracer uptake in the left sternoclavicular joint with fluid collections extending into the sternocleidomastoid muscle and the mediastinum. Imaging findings were consistent with septic arthritis and abscess formation, despite lack of fever or localizing symptoms. Ultrasound-guided aspiration revealed purulent fluid that grew Moraxella nonliquefaciens. Given the unusual presentation, ongoing clinical uncertainty about the true cause of the septic joint, and concern for an occult sarcoma metastasis, surgical debridement and resection of the joint was carried out. Pathology and microbiology evaluation confirmed septic arthritis with osteomyelitis and abscess extension into the mediastinum. No tumor cells were identified. Postoperative course was complicated by hematoma, but otherwise the patient responded well to antimicrobial therapy.
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Affiliation(s)
- Ehab Saad Aldin
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Poorani Sekar
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Zein Saad Eddin
- Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
| | - Jaclyn Keller
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Janet Pollard
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
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Gill JR, Morrissey DI, Van Rensburg L, Tytherleigh-Strong G. Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow. BMJ Case Rep 2017; 2017:bcr-2016-219053. [PMID: 28687685 DOI: 10.1136/bcr-2016-219053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted. A subsequent CT scan of his neck demonstrated osteoarthritis of the right SCJ with an abnormally large posterior osteophyte. The patient was subsequently referred on to an orthopaedic surgeon specialising in SCJ surgery and underwent an arthroscopic excision of his right SCJ. Soon after surgery, the patient's dysphagia had settled and his symptoms remain resolved 1 year post surgery.
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Affiliation(s)
- James Ritchie Gill
- Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David I Morrissey
- Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lee Van Rensburg
- Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Arrizabalaga M, Borjas Y, Peñaranda M, Garau M, Ruíz de Gopegui E, Payeras A. Osteoarticular infections caused by Streptococcus pneumoniae since authorization of conjugate vaccines. ACTA ACUST UNITED AC 2017; 15:e62-e65. [PMID: 28599870 DOI: 10.1016/j.reuma.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- María Arrizabalaga
- Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España.
| | - Yolanda Borjas
- Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España
| | - María Peñaranda
- Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Margarita Garau
- Servicio de Microbiología, Hospital Son Llàtzer, Palma de Mallorca, España
| | | | - Antoni Payeras
- Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España
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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
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