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Chan DH, Lee MT, Zhang AQ, Ton EH, Wang SJ. Culture-negative primary sternal osteomyelitis in a patient with uncontrolled type 2 diabetes mellitus. Radiol Case Rep 2022; 17:3019-3024. [PMID: 35755117 PMCID: PMC9214721 DOI: 10.1016/j.radcr.2022.05.086] [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: 05/21/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/21/2022] Open
Abstract
Primary sternal osteomyelitis (PSO) is a rare condition defined as an infection of the sternal bone marrow with no contiguous source of infection. The overlap in symptoms of PSO with other cutaneous and malignant pathologies often leads to misdiagnosis and delay of appropriate care. In this case report, we outline the presentation of PSO in a 30 year-old male patient who was newly diagnosed with type 2 diabetes mellitus. The patient was successfully treated with antibiotic therapy alone, without need for surgical intervention. Interestingly, the patient's workup returned with negative microbial cultures. To our knowledge, this patient represents the first reported case of a spontaneously presenting, culture-negative PSO.
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Affiliation(s)
- David H. Chan
- Southern Hills Hospital and Medical Center, 9300 W Sunset Rd, Las Vegas, NV, 89145, USA
- HCA Healthcare, Nashville, TN, USA
- Corresponding author.
| | - Michael T. Lee
- Southern Hills Hospital and Medical Center, 9300 W Sunset Rd, Las Vegas, NV, 89145, USA
- HCA Healthcare, Nashville, TN, USA
| | - Amy Q. Zhang
- Southern Hills Hospital and Medical Center, 9300 W Sunset Rd, Las Vegas, NV, 89145, USA
- HCA Healthcare, Nashville, TN, USA
| | - Erinn H. Ton
- Southern Hills Hospital and Medical Center, 9300 W Sunset Rd, Las Vegas, NV, 89145, USA
- HCA Healthcare, Nashville, TN, USA
| | - Shyh-Jeun Wang
- Southern Hills Hospital and Medical Center, 9300 W Sunset Rd, Las Vegas, NV, 89145, USA
- HCA Healthcare, Nashville, TN, USA
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Qian M, Wang J, Li J, Wang S, Wang Z, Chen X, Ou H, Liang Y, Peng X. Role of ultrasound and CT in the early diagnosis and surgical treatment of primary sternal osteomyelitis caused by Salmonella: Case reports. Exp Ther Med 2021; 21:189. [PMID: 33488798 PMCID: PMC7812590 DOI: 10.3892/etm.2021.9620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022] Open
Abstract
Primary sternal osteomyelitis (PSO) caused by Salmonella is a rare condition and most commonly associated with sickle cell disease. Only one such case has been previously reported in an infant (age, <1 year) worldwide. The present study reported on two infantile cases of PSO caused by Salmonella in the absence of any hematological diseases. A total of two male infants (age, ≤1 year) were referred to our hospital for fever and rapid breathing accompanied by a chest wall mass involving the lower end of the sternum. Imaging findings on CT and ultrasound, which included sternal segment dislocation, lytic destruction and periosteal elevation, confirmed the diagnosis of PSO. Blood and purulent material cultures confirmed that the causative pathogen was Salmonella. The infants were completely cured by sequential intravenous and oral antibiotics followed by surgical debridement. The infants remained symptom-free and local recurrence of PSO was not detected at follow-up. PSO caused by Salmonella in the absence of any hematological diseases is a rare condition. Unfamiliarity with this disease may lead to a delay in diagnosis and serious complications. The current case report presents two cases of PSO along with a brief overview of the characteristics and management modalities for this condition, and it provides a comprehensive reference for pediatricians regarding this rare disease, particularly in infants.
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Affiliation(s)
- Mengjiao Qian
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Jing Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Jun Li
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Sibo Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Zhongyin Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Xiao Chen
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Haibo Ou
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Yuanzhong Liang
- Department of Radiology, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
| | - Xuguan Peng
- Department of Cardiothoracic Surgery, The First People's Hospital of Honghe Prefecture, Mengzi, Yunnan 661100, P.R. China
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Sayed S, Prabhu S, Thomas M, McBride CA, Alphonso N. Primary Sternal Osteomyelitis With Extensive Mediastinal Abscess in a Neonate. Ann Thorac Surg 2016; 100:e85-7. [PMID: 26434486 DOI: 10.1016/j.athoracsur.2015.05.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 11/16/2022]
Abstract
Sternal osteomyelitis is extremely rare in neonates. We present the first report of a neonate with primary sternal osteomyelitis and an extensive mediastinal collection. Magnetic resonance imaging was used to delineate the extent of bony and soft tissue involvement. Serial ultrasound imaging proved useful for monitoring the response to treatment. The patient was successfully treated with antibiotics, surgical débridement, vacuum-assisted dressings, and delayed primary closure.
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Affiliation(s)
- Sajid Sayed
- Department of Queensland Paediatric Cardiac Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sudesh Prabhu
- Department of Queensland Paediatric Cardiac Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marion Thomas
- Department of Paediatric Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Craig A McBride
- Department of Paediatric Surgery, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Nelson Alphonso
- Department of Queensland Paediatric Cardiac Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Primary osteomyelitis of the sternum in the pediatric age group: report of a new case and comprehensive analysis of seventy-four cases. Pediatr Infect Dis J 2015; 34:e92-e101. [PMID: 25764104 DOI: 10.1097/inf.0000000000000597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric primary osteomyelitis of the sternum may have a non-specific onset and be diagnosed late. We analyzed all accessible published cases (n = 73) and 1 new case in order to describe presenting signs and symptoms, laboratory findings, diagnostic imaging features, causative pathogens, treatments, complications and outcomes. This analysis represents the first comprehensive description of the natural history of this rare infection.
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de Nadai TR, Daniel RF, de Nadai MN, da Rocha JJR, Féres O. Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report. J Med Case Rep 2013; 7:167. [PMID: 23806012 PMCID: PMC3700748 DOI: 10.1186/1752-1947-7-167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Primary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy. Case presentation A 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient. Conclusions The satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.
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Affiliation(s)
- Tales Rubens de Nadai
- Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, Brazil Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
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