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

Fornwalt, Brandon E.; Goosmann, Madeline M.; Reynolds, Stephen; Bunevich, Jared

doi:10.1177/2050313x20902874

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…Treatment consisted of urgent surgery for cervical and mediastinal abscesses and concurrent antibiotic therapy. Abscess formation in the posterior sternum occurs in 28% of cases and can lead to life-threatening complications, such as mediastinitis and superior vena cava syndrome [ 5 , 12 ]. Pyogenic sternoclavicular arthritis and deep neck abscess are both fatal diseases and, even in patients with COVID-19, invasive treatment should be performed to prevent infection.…”

Section: Discussionmentioning

confidence: 99%

“…Deep neck abscess is a fatal disease usually caused by descending infection of the oral cavity or upper respiratory tract, such as tonsillitis or dental infection. Although few cases have been reported, pyogenic sternoclavicular arthritis can be a cause of deep neck abscess [ 5 ]. There are limited reports of cervical infections associated with COVID-19, and 1 report of a case with cervical abscesses [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Case of a Deep Neck Abscess During Treatment for COVID-19

et al. 2022

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Patient: Male, 55-year-old Final Diagnosis: COVID 19 infection • deep neck infection • pyogenic arthritis Symptoms: Neck pain • shoulder pain Medication: Antibiotics Clinical Procedure: Incisional drainage Specialty: Otolaryngology Objective: Unusual clinical course Background: COVID-19 is treated using antiviral and immunosuppressive drugs. Therefore, patients treated for COVID-19 may have an increased risk of secondary infection and a masked inflammatory response. We present a case of a deep neck abscess caused by pyogenic sternoclavicular arthritis during treatment for COVID-19. Case Report: A 55-year-old man with COVID-19 was admitted to the hospital with hypoxemia. He was then treated with remdesivir, tocilizumab, and dexamethasone and was placed in the prone position. When his condition stabilized, pain in the left shoulder appeared. There was no fever or elevation in inflammation markers, and he was administered analgesics. However, the pain worsened and redness of the left neck appeared. Plain computed tomography (CT) showed swelling of the left neck muscles. Because cellulitis was suspected, he was treated with antibiotics, but his symptoms did not improve. Three days after the plain CT, contrast-enhanced CT showed sternoclavicular arthritis, deep neck abscess, and mediastinal abscess. Therefore, an emergency incisional drainage was performed under general anesthesia. Wound cleaning and drainage were continued after surgery, and after drainage tubes were removed, the patient was discharged on postoperative day 17. Conclusions: Cervical infections after COVID-19 treatment have been reported in a few cases. Particularly, deep neck abscesses require more attention since they could be fatal if not treated immediately. If a secondary infection is suspected in a patient treated with immunosuppressive drugs for COVID-19, a thorough physical examination should be performed to avoid misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case of a Deep Neck Abscess During Treatment for COVID-19

et al. 2022

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“…Abscess formation can be commonly seen at the time of diagnosis [ 13 ]. The location of the abscess varies and can include chest wall abscess, or rarely cervical abscess [ 14 , 15 ]. Because of the subtle symptoms, diagnosis may be delayed due to the attribution of clinical symptoms to other diagnoses such as muscle strain or osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

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

Alhariri¹,

Kalas²,

Hassan³

et al. 2022

Cureus

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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.

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“…Warmth and redness around the afflicted joint, as well as other signs of joint inflammation, may occur [ 9 ]. In addition, other cases may present with less common manifestations, such as abscess formation and subcutaneous emphysema [ 10 ]. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are utilized for the evaluation of infection severity [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Sternoclavicular Septic Arthritis and Surgical Intervention: A Case Report

Alnasser,

Alamari,

Almutairi

et al. 2024

Cureus

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

Cited by 3 publications

References 15 publications

Case of a Deep Neck Abscess During Treatment for COVID-19

Case of a Deep Neck Abscess During Treatment for COVID-19

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

Sternoclavicular Septic Arthritis and Surgical Intervention: A Case Report

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