Spontaneous Bilateral Sternoclavicular Joint Septic Arthritis and Lumbar Discitis: An Unusual Case in a Healthy Adult

Abstract

Introduction Septic arthritis of the sternoclavicular (SC) joint is a rare condition. Typically, it presents in patients with risk of infection and is usually unilateral. In this report, we describe a case of spontaneous bilateral sternoclavicular joint infection of an otherwise healthy adult. Case Presentation A 67-year-old man presented in our hospital complaining of 2-week history of neck and chest pain which was radiating to his shoulders bilaterally. Clinical examination revealed erythema and swelling of the sternoclavicular area. Inflammatory markers were raised. Image investigation with CT and MRI was undertaken and verified the presence of bilateral sternoclavicular joint infection. The patient received prolonged course of intravenous antibiotics since his admission. The patient was discharged in a good condition and followed up in clinic. Conclusion High index of clinical suspicion of SC joint infection is important for early diagnosis to avoid further complications.

Acute Sternoclavicular Joint Sepsis With Medial Clavicle Osteomyelitis (Staphylococcus aureus) and Cervical-Thoracic Epidural Phlegmon in an Adult Female With No Apparent Risk Factors

“…Most cases of epidural abscesses/phlegmons are related to episodes of an invasion of skin flora (e.g., therapeutic injections), with S. aureus identified in approximately two-thirds of cases [ 21 - 23 ]. We only found two previously published cases that reported concurrent SCJ infection and some form of epidural/paraspinous infection (abscess, phlegmon, and/or discitis) [ 13 , 14 ]. Shioya N et al [ 13 ] described a 61-year-old male with poorly controlled diabetes who developed a lumbar epidural abscess and SCJ infection from epidural injections for an L4-L5 disc herniation.…”

“…SCJ, blood, and urine cultures grew S. aureus, but the subsequent aspiration of the epidural abscess showed no growth. Mamarelis G et al [ 14 ] reported the case of a 67-year-old male with a medical history of hypertension and gout that developed bilateral SCJ septic arthritis and lumbar discitis (there was no antecedent injection). Surgery and aspirations were not done for the spine or SCJ infections.…”

“…When osteomyelitis is present, surgical intervention with bone debridement is often required [ 2 , 4 , 11 , 12 ]. Only a few studies have reported the co-existence of SCJ infection and some form of epidural/paraspinous infection (abscess, phlegmon, and/or discitis) [ 13 , 14 ]. In these prior studies, the patients’ infections were in the lumbar region; we could not locate a report of a concurrent SCJ infection and a cervical-thoracic epidural abscess or phlegmon.…”

Diagnosis and management of sternoclavicular joint infections: a literature review

“…Unilateral SCJI can often present with fever, joint swelling, warmth and immobility. Bilateral infections can present as a butterfly rash on the chest (19). Some unusual presentations have also been reported in literature, such as a pressure like chest pain radiating to the neck or shoulder.…”

Salmonella Sternoclavicular Septic Arthritis in a Non-sickle Cell Disease Patient

“…The presentation of SCJ septic arthritis can present as chest pain radiating down the arm. The low prevalence and ambiguous presentation of SCJ often delay its diagnosis of septic arthritis [ 6 , 7 ]. Currently, no standardized diagnostic and therapeutic algorithms for SCJ infection exist, as defined in the literature [ 8 ].…”