Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report

Abstract

The sternoclavicular joint (SCJ) is an uncommon location for septic arthritis to occur in. Due to the rarity of the condition and the nonspecific symptoms, SCJ septic arthritis can be missed or mislabeled as osteoarthritis or muscle strain. Accurate history and physical examination is crucial for recognizing this condition. With the potential life-threatening complications that may ensue, SCJ septic arthritis has traditionally been managed surgically. This ranges from simple incision and drainage to resection of the joint. However, in cases where there is not enough fluid for incision and drainage, a trial of medical management with antibiotics can be attempted. We herein describe a case of a 58-year-old male who presented with nonspecific anterior chest wall and neck pain. Chest X-ray and ultrasound of the anterior chest wall was normal; however, magnetic resonance imaging (MRI) of the chest showed a small effusion without other complications. His blood cultures grew extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, rendering this as his hematogenous source of septic arthritis. The ESBL was from a left-sided obstructing kidney stone that resulted in pyelonephritis, which was confirmed via computed tomography of the abdomen. His effusion was too minimal to drain; therefore, he was managed medically with intravenous (IV) antibiotics along with a left ureteral stent placement, and he had a full recovery. This case represents the ability for SCJ septic arthritis to be managed medically with IV antibiotics, especially when the diagnosis is caught early without complications. The role of MRI is indispensable for coming to the diagnosis, as it is capable of detecting complications that ultimately dictate management. Additionally, this case highlights the unique microorganism, ESBL-producing E. coli causing the SCJ septic arthritis , a finding that has been rarely reported in the literature as the majority of microorganisms that have been previously documented are either Staphylococcus aureus or Pseudomonas aeruginosa.

Exclusively Oral Treatment for Osteoarticular Infections in Children. Is It Time?

“…Septic arthritis of small or hard-to-reach joints like the sacroiliac, sternoclavicular, or interphalangeal joints poses challenges when it comes to aspiration, particularly in children. Consequently, in such cases, it may be advisable to consider a trial of medical management using antibiotics as an alternative approach to surgery [16,20,21]. In patients from whom a sample from the site of infection cannot be obtained, the detection of K. kingae DNA in the oropharynx could point to the etiology by this agent [22].…”

Minimally invasive management of pediatric osteoarticular infections

“…Finally, small or difficult-to-access joints such as sacroiliac, sternoclavicular, or interphalangeal are notoriously more difficult to aspirate, especially in children. For this reason, in these cases, a trial of medical management with antibiotics could be attempted (20,48,49). In patients in whom a sample from the site of infection cannot be obtained, detection of K. kingae DNA in oropharynx could point to etiology by this bacterium (50).…”

Septic Arthritis of the Sternoclavicular Joint

“…However, more than 25% of patients have no risk factors. 2 , 3 Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis or myositis. 4 , 5 Thus, a high index of suspicion with prompt recognition and management in the emergency department (ED) is vital to avoid poor outcomes.…”