Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report

Abstract

BackgroundSeptic arthritis of the sternoclavicular joint is rare. It can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. In this report, we describe a case of an otherwise healthy adult with septic arthritis of the sternoclavicular joint with chest wall abscess.Case presentationA 68-year-old Japanese man presented to our hospital complaining of pain and erythema near the right sternoclavicular joint. Despite 1 week of oral antibiotics, his symptoms did not improve. Computed tomography revealed an abscess with air around the right pectoralis major muscle. After being transferred to a tertiary hospital, emergency surgery was performed. Operative findings included necrotic tissue around the right sternoclavicular joint and sternoclavicular joint destruction, which was debrided and packed open. Methicillin-susceptible Staphylococcus aureus was identified in blood and wound cultures. Negative pressure wound therapy and hyperbaric oxygen therapy were performed for infection control and wound healing. The patient’s general condition improved, and good granulation tissue developed. The wound was closed using a V-Y flap on hospital day 48. The patient has been free of relapse for 3 years.ConclusionsSeptic arthritis of the sternoclavicular joint is an unusual infection, especially in otherwise healthy adults. Because it is associated with serious complications such as chest wall abscess, prompt diagnosis and appropriate treatment are required.

Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report

“…Abscess specifically was found about 20% of the time; however, the majority were located in the chest wall. 11 Similarly, Akkasilpa et al 12 found that retrosternal abscesses developed in 28% of patients from SCJ septic arthritis. A cervical abscess is exceedingly rare with our case being the second reported.…”

Early Detection of Inflammation and Joint Destruction Revealed by Ultrasound in a Patient with Sternoclavicular Septic Arthritis

“…Imaging supports the diagnosis of sternoclavicular septic arthritis, but the initial plain radiographs are normal in most such patients (3, 6). CT or MRI should be routinely performed in all cases of sternoclavicular joint arthritis (3-7). If life-threatening complications (such as chest wall phlegmon or abscess, retrosternal abscess, mediastinitis, or pleural extension) are observed, joint resection is indicated.…”

“…Plain radiography may show osteolysis and osteosclerosis in the distal clavicle, but the findings may seem normal initially (3). Because of the limited information that plain radiography provides, the use of magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound may aid in the arrival at a precise diagnosis (3-7). Ultrasound has increasing utility in the diagnosis of musculoskeletal conditions when used by an experienced clinician (6).…”

Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications

“…Sternoclavicular joint (SCJ) infection is an uncommon condition, accounting for only 0.5 %-1.0 % of all septic arthritis and less than 0.5 % of septic arthritis in healthy patients (Tanaka et al, 2016). Several risk factors have been associated with SCJ infection, including intravenous drug use, concomitant infection at a different location, diabetes mellitus, trauma, and central venous line-related infection.…”