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Sugihara T, Sano Y, Ueki T, Ishimura T, Takeda M, Kiriyama Y, Mori Y, Sakao N, Otani S, Izutani H. Successful conservative management of advanced pyogenic sternoclavicular joint arthritis with osteomyelitis and pulmonary infiltration: a case report. J Med Case Rep 2024; 18:394. [PMID: 39183313 PMCID: PMC11346202 DOI: 10.1186/s13256-024-04684-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/05/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Sternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy. CASE PRESENTATION A 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up. CONCLUSIONS This case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options.
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Affiliation(s)
- Takahito Sugihara
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan.
| | - Yoshifumi Sano
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Takashi Ueki
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Takao Ishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Masashi Takeda
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Yosuke Kiriyama
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Yu Mori
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Nobuhiko Sakao
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Shinji Otani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454, Shitsukawa, Toon, Ehime, 791-0204, Japan
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2
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Khoo CY, Chia CML. A challenging case of severe bilateral septic arthritis with osteomyelitis of the sternoclavicular joint in a patient with end-stage renal disease. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae080. [PMID: 38676666 PMCID: PMC11087927 DOI: 10.1093/icvts/ivae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 04/29/2024]
Abstract
Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition that comprises <1% of all joint infections. We report a case of severe bilateral septic arthritis of the SCJ in a patient with end-stage renal disease on peritoneal dialysis. A 44-year-old female presented with right SCJ infection 1 month after recovering from a tenckhoff catheter exit-site infection. She completed 6 weeks of antibiotics however this progressed to bilateral SCJ septic arthritis with osteomyelitis necessitating multiple surgical debridement and excision of bilateral clavicular heads. Further imaging showed signs of renal osteodystrophy and degenerative joint changes resembling calcium pyrophosphate deposition. Patients with end-stage renal disease have multiple risk factors including immune system dysfunction, renal osteodystrophy and dialysis access sites that increase susceptibility to bacteraemia and seeding. Therefore in such patients, prompt assessment is necessary to ensure expeditious diagnosis and treatment of this potentially debilitating condition. A multidisciplinary team involving various specialties is crucial for the holistic care for such patients and to reduce the risk of recurrence.
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Affiliation(s)
- Chun Yuet Khoo
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Cynthia Ming Li Chia
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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3
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Koike S, Miyazawa M, Kobayashi N. A rare case of empyema caused by septic arthritis of the sternoclavicular joint, successfully treated with surgical drainage. J Surg Case Rep 2024; 2024:rjae359. [PMID: 38817792 PMCID: PMC11137752 DOI: 10.1093/jscr/rjae359] [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] [Received: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
Septic arthritis of the sternoclavicular joint is a rare joint infection, and it sometimes leads to a chest wall abscess or mediastinitis. We report a case of a 70-year-old man who was diagnosed with empyema caused by an anterior chest wall abscess extended from septic arthritis of the sternoclavicular joint. It is very rare that arthritis causes empyema combined with an anterior chest wall abscess, and this is the first report of such a case. The patient was successfully treated with surgical drainage.
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Affiliation(s)
- Sachie Koike
- Department of Thoracic Surgery, Japan Red Cross Society Nagano Hospital, 5-22-1, Wakasato, Nagano, Nagano 380-8582, Japan
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Masahisa Miyazawa
- Department of Thoracic Surgery, Japan Red Cross Society Nagano Hospital, 5-22-1, Wakasato, Nagano, Nagano 380-8582, Japan
| | - Nobutaka Kobayashi
- Department of Thoracic Surgery, Japan Red Cross Society Nagano Hospital, 5-22-1, Wakasato, Nagano, Nagano 380-8582, Japan
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4
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Pothini T, Wilmot CD, Waters JK, Wait MA, Reznik SI, Jordan KG, Caire JT, Ashworth JM, Cady LC, Lysikowski JR, Yen CF, Weinschenk RC, Samade R, Jessen ME, Kusiak A, Kernstine KH. Clinical and radiological septic joint analysis of spontaneous sternoclavicular joint infections: achieving the best outcomes-a systems engineering approach. Eur J Cardiothorac Surg 2024; 65:ezae128. [PMID: 38547389 DOI: 10.1093/ejcts/ezae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using data mining. METHODS An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes. RESULTS A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients [mean age 51 (22-82); 77% male] met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis. CONCLUSIONS This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection.
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Affiliation(s)
- Tanushri Pothini
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles D Wilmot
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - John K Waters
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott I Reznik
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kirk G Jordan
- Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline T Caire
- Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John M Ashworth
- Department of Health Systems Planning and Analytics, Parkland Hospital, Dallas, TX, USA
| | - Leah C Cady
- Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jerzy R Lysikowski
- Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christina F Yen
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert C Weinschenk
- Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA
| | - Richard Samade
- Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew Kusiak
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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5
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Princess I, Theckumparampil NPJ, Dorairajan SK. Salmonella Typhi sternoclavicular abscess with osteomyelitis-a rare case report. Indian J Thorac Cardiovasc Surg 2024; 40:250-253. [PMID: 38389760 PMCID: PMC10879046 DOI: 10.1007/s12055-023-01648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 02/24/2024] Open
Abstract
Salmonella Typhi osteomyelitis is a rare occurrence as compared to enteric fever and diarrhoea which are common manifestations caused by this microorganism. In reported cases of Salmonella osteomyelitis, commonly involved sites are long bones like the femur and humerus. Uncommon reports of Salmonella osteomyelitis from sites such as radius, ulna, tibia and vertebrae have also emerged. Extremely rare incidences of the same have been reported from the clavicle, skull and small bones of hands. Osteomyelitis could be bacterial or non-bacterial, and among bacterial osteomyelitis, Salmonella Typhi is a very rare entity. We present a case of Salmonella osteomyelitis and discuss the importance of microbiological diagnosis of osteomyelitis in diagnosing unusual pathogens from unusual sites. This case report is unique due to its site and difference in clinical presentation. The difference in presentation in an elderly immunocompetent male with no major comorbidities was different from other reported cases. Our patient was successfully managed with surgical debridement followed by a series of vacuum dressings and intravenous antibiotics for 6 weeks.
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Affiliation(s)
- Isabella Princess
- Department of Microbiology, Apollo Speciality Hospitals, Vanagaram, Chennai, 600095 India
| | | | - Suresh Kumar Dorairajan
- Department of Infectious Diseases, Apollo Speciality Hospitals, Vanagaram, Chennai, 600095 India
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6
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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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7
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Jlidi M, Bouaicha W, Nouicer S, Mallek K, Chaabane I, Bachrouch S, Daas S. Sternoclavicular septic arthritis in a healthy adult: A case report and a review of the literature. SAGE Open Med Case Rep 2023; 11:2050313X231212831. [PMID: 38022866 PMCID: PMC10666677 DOI: 10.1177/2050313x231212831] [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: 09/18/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Sternoclavicular joint septic arthritis is rare and commonly associated with specific risk factors. We report the case of a 58-year-old female with no previous medical or surgical history who presented complaining of a warm, indurated mass overlying the right sternoclavicular joint. Computed tomography of the chest showed erosion of the sternal end of the clavicle and the manubrium sternum associated with thickening of the synovium and a sternoclavicular joint space narrowing, suggestive of an infective process. Intraoperative finds a purulent collection extending both over the clavicle and the sternum. Limited destruction of small parts of the sternoclavicular joint was noted. The abscess was drained. Simple debridement and limited curettage were preferred to en bloc resection given the limited size of necrotic tissues. Sternoclavicular joint septic arthritis is a condition with significant morbidity and potential mortality. All medical practitioners must maintain a high degree of suspicion, even in healthy patients, as it can lead to serious complications.
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Affiliation(s)
- Mohamed Jlidi
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Walid Bouaicha
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Saffet Nouicer
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Imene Chaabane
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Sabrine Bachrouch
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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8
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Cydylo M, Ivanov I, Chineme J. Sternoclavicular Septic Arthritis: A Case Report. Cureus 2023; 15:e38130. [PMID: 37252575 PMCID: PMC10212690 DOI: 10.7759/cureus.38130] [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: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
We report a case of a 47-year-old male who presented with concerns for a "mass" on the right side of his chest and low-grade fevers for the last month. The patient was found to have an induration, erythema, and warmth at the right sternoclavicular joint, with tenderness to palpation and pain in the movement of the right arm. The patient was found to have septic arthritis of the sternoclavicular joint based on CT imaging. Sternoclavicular joint septic arthritis is a rare diagnosis and accounts for very few diagnosed septic joints. Most patients have some sort of risk factors, such as diabetes, immunosuppression, rheumatoid arthritis, or intravenous drug use. The most common pathogen is Staphylococcus aureus. Our patient did not consent to joint aspiration for a definitive diagnosis of the causative organism and was therefore empirically treated for S. aureus with trimethoprim-sulfamethoxazole. The patient also did not consent to any surgical management. Septic arthritis has been successfully treated with antibiotic therapy alone in the past, and in conjunction with the patient's choices, this was the treatment plan that was chosen for the patient. The patient responded to antibiotic therapy and followed up with a thoracic surgery clinic outpatient. This case depicts the importance of retaining a high index of suspicion for a rare diagnosis in the emergency department (ED). This case also depicts the successful treatment of sternoclavicular septic arthritis with outpatient oral trimethoprim-sulfamethoxazole, which, to the best of our knowledge, has not been done previously.
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Affiliation(s)
- Michael Cydylo
- Emergency Department, New York City Health and Hospitals - South Brooklyn Health, Brooklyn, USA
| | - Ivan Ivanov
- Emergency Department, New York City Health and Hospitals - South Brooklyn Health, Brooklyn, USA
| | - Jessica Chineme
- Emergency Department, New York City Health and Hospitals - South Brooklyn Health, Brooklyn, USA
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9
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Minimally Invasive Surgery for Sternoclavicular Joint Infection with Osteomyelitis, Large Abscesses, and Mediastinitis. Case Rep Surg 2022; 2022:9461619. [PMID: 36317047 PMCID: PMC9617732 DOI: 10.1155/2022/9461619] [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: 09/04/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Sternoclavicular joint infections require en bloc resection for radical cure; however, this aggressive procedure may result in multiple adverse events. Therefore, performing minimally invasive surgery is desirable. In this report, we describe a case of sternoclavicular joint infection complicated by osteomyelitis, large abscesses, and mediastinitis that was successfully treated with incision and drainage. Case Presentation. A 42-year-old man with no medical history presented to our hospital with complaints of painful swelling in the left chest wall and acute dyspnea. Computed tomography revealed arthritis of the left sternoclavicular joint, osteomyelitis of the clavicle and sternum, anterior mediastinitis, and abscesses in the neck, chest wall, and retrosternal and extrapleural spaces. Gram staining of the aspirated pus revealed clusters of gram-positive cocci. A diagnosis of Staphylococcus aureus sternoclavicular joint infection with locoregional spread was made. Emergency surgery was performed following adequate resuscitation. A skin incision was made in the second intercostal space. The joint capsule was widely opened, necrotic tissue was curetted, and closed suction drains were placed in the abscess cavities and connected to a negative pressure system. The wound was then closed using primary sutures. The postoperative course was uneventful. Methicillin-sensitive Staphylococcus aureus was cultured from the pus. The patient was discharged on postoperative day 14. Osteomyelitis worsened within a few weeks after surgery but recovered with wound management and six weeks of antibiotic therapy. The patient has had no recurrence of infection for two years. Conclusions Incision and drainage proved to be an effective minimally invasive surgical treatment for sternoclavicular joint infection with osteomyelitis, large abscesses, and mediastinitis caused by methicillin-sensitive Staphylococcus aureus.
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10
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Mitsusada K, Dote H, Saito R, Atsumi T. Mediastinal abscess in an immunocompromised patient which progressed from sternoclavicular joint septic arthritis. BMJ Case Rep 2022; 15:e252103. [PMID: 36129356 PMCID: PMC9438062 DOI: 10.1136/bcr-2022-252103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kenta Mitsusada
- Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hisashi Dote
- Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ryusuke Saito
- Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takahiro Atsumi
- Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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11
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Alhariri S, Kalas MA, Hassan M, Carter JT, Ghafouri SR, Dihowm F. Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report. Cureus 2022; 14:e23969. [PMID: 35547421 PMCID: PMC9088884 DOI: 10.7759/cureus.23969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
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12
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Chang MC, Boudier-Revéret M. Unilateral sternoclavicular arthritis: inflammatory arthritis or septic arthritis, that is the question - a case report. J Int Med Res 2022; 50:3000605221089786. [PMID: 35387512 PMCID: PMC9003653 DOI: 10.1177/03000605221089786] [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] [Indexed: 11/24/2022] Open
Abstract
Sternoclavicular (SC) joint inflammatory arthritis and septic arthritis can have very similar presentations and can be indistinguishable if a joint fluid aspiration sample cannot be obtained. Septic arthritis of the SC joint accounts for less than 1% of all joint infections. Diagnosis is usually made on the basis of the clinical history combined with elevated infection markers in the blood, specific imaging findings, and most importantly, a positive joint aspiration bacterial culture. To make a diagnosis of SC joint septic arthritis, a high index of suspicion is generally necessary. We herein present the case of a previously healthy 52-year-old man with a 10-day history of left SC pain who improved transiently with anti-inflammatory oral medication; however, the pain subsequently increased over the next 10 days. Follow-up magnetic resonance imaging of the left SC area revealed fluid in the joint with an abscess adjacent to the joint, which was aspirated, and the sample yielded a positive Streptococcus agalactiae culture. Septic arthritis of the left SC joint was diagnosed, and the patient was treated surgically. This case highlights the initial challenges of distinguishing inflammatory from septic arthritis in joints in which a sample for bacterial culture cannot be easily obtained.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, Canada
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13
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Gonçalves RB, Grenho A, Correia J, Reis JE. Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications. J Bone Jt Infect 2021; 6:389-392. [PMID: 34745846 PMCID: PMC8567852 DOI: 10.5194/jbji-6-389-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022] Open
Abstract
We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.
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Affiliation(s)
- Rui Barbeiro Gonçalves
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Grenho
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Correia
- Orthopaedics and Trauma Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Eurico Reis
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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14
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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.
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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
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Wako Y, Sakamoto M, Rokkaku T, Motegi H, Watanabe H, Yamada T, Yamaguchi T, Inagaki K, Maruyama J, Ueta T. A case of hip joint septic arthritis due to haematogenous infection, which was misdiagnosed sternoclavicular joint septic arthritis as SAPHO syndrome. Mod Rheumatol Case Rep 2021; 5:409-413. [PMID: 33427583 DOI: 10.1080/24725625.2020.1869510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anterior chest pain associated with sternoclavicular arthritis has been considered a symptom specific to SAPHO syndrome. Differentiating aseptic arthritis of the SAPHO syndrome from infectious sternoclavicular joint (SCJ) arthritis is often difficult. We reported a 55-year-old woman with left hip joint and right SCJ pain. Diagnosis and treatment were delayed because she was misdiagnosed with SAPHO syndrome, and haematogenous infection spread to the hip joint septic arthritis. She was diagnosed promptly after presenting to our hospital and underwent early debridement, and her hip joint and SCJ was found to have almost no dysfunction. Differentiation between sternoclavicular arthritis of the SAPHO syndrome and sternoclavicular septic arthritis is clinically important and requires careful attention.
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Affiliation(s)
- Yasushi Wako
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Masaaki Sakamoto
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Tomoyuki Rokkaku
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hiroyuki Motegi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hitoshi Watanabe
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toshiyuki Yamada
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Kenta Inagaki
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Juntaro Maruyama
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toru Ueta
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
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Hanhoff M, Jensen G, Dey Hazra RO, Lill H. Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:64-73. [PMID: 32927491 DOI: 10.1055/a-1219-8342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 - 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. PATIENT AND METHOD According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the "figure of eight" technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. RESULTS AND CONCLUSION One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authors' knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.
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Affiliation(s)
- Marek Hanhoff
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
| | - Gunnar Jensen
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
| | | | - Helmut Lill
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
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17
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Ali B, Barlas V, Shetty AK, Demas C, Schwartz JD. The Preferred Treatment of Sternoclavicular Joint Infections: A Systematic Review. Cureus 2020; 12:e9963. [PMID: 32983667 PMCID: PMC7510516 DOI: 10.7759/cureus.9963] [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: 07/06/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
The treatment of sternoclavicular joint infection is a topic of controversy. This systematic review aims to evaluate the preferred treatment of sternoclavicular joint infections. A literature search using PubMed/MEDLINE®/Embase databases was conducted to identify publications on the surgical management of sternoclavicular joint infections. Case reports and studies without surgical management were excluded. The outcomes of interest included patient demographics, comorbidities, infectious etiologies, radiographic features, surgical management, and complications. Sixteen articles met the inclusion criteria. The mean age of the subjects was 53.4 years; there was a predominance of males (65%), and a minority of the subjects were obese (15%). The most common infectious etiology was methicillin-susceptible Staphylococcus aureus (MSSA) (48%). CT scan was reported in 46% of cases. The most common treatment was surgical resection of the joints (85%), followed by muscle flap closure of the wounds (54.2%). The complication rate ranged from 0-40%. Specifically, recurrence of infection was low with resection of the joint, followed by muscle flap closure. Given the heterogeneity of the methodology and inconsistency in the outcomes, a meta-analysis could not be performed. Overall, the current literature favors the resection of the sternoclavicular joint as the gold standard treatment. Closure of the wound using muscle flap seems to adequately treat this problem without any major untoward events.
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Affiliation(s)
- Barkat Ali
- Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Venus Barlas
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Anil K Shetty
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Christopher Demas
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Jess D Schwartz
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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18
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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.
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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
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19
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Ali B, Shetty A, Qeadan F, Demas C, Schwartz JD. Sternoclavicular Joint Infections: Improved Outcomes With Myocutaneous Flaps. Semin Thorac Cardiovasc Surg 2020; 32:369-376. [DOI: 10.1053/j.semtcvs.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/14/2019] [Indexed: 11/11/2022]
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