Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult

Abstract

Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient’s blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause.

Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

“…Primary osteomyelitis of the sternum in immunocompetent patients is extremely rare, accounting for 0.3% of all cases of osteomyelitis reported in the literature (1). Common risk factors for primary sternal osteomyelitis are trauma, pneumonia, diabetes, immunodeficiency, or history of IV drug use (2,3). Our patient had none of these risk factors.…”

“…Our patient had none of these risk factors. Risks for secondary sternal osteomyelitis are due to complications from sternal incision post-thoracic surgery (1)(2)(3). Staphylococcus aureus is the most common organism of both primary and secondary sternal osteomyelitis (2).…”

Primary Sternal Osteomyelitis caused byStaphylococcus aureusin an Immunocompetent Adult

“…Clinicians should consider infectious causes of chest pain when symptoms, such as fever, cardiac murmur, and elevated WBC count are combined. The differential diagnosis should include skin and soft tissue infections, including cellulitis and shingles; musculoskeletal sources of chest pain, such as costochondritis and fibromyalgia; pericarditis, myocardial infarction, valvular abnormalities and cardiomyopathy; benign soft tissue tumors; and bone sarcomas [ 3 5 ].…”

“…In contrast, primary sternal osteomyelitis (PSO) has no contiguous focus of infection, which is uncommon; it occurs in intravenous drug abusers and patients with diabetes or those infected with human immunodeficiency virus (HIV), which predisposes individuals to infection [ 2 ]. Without any predisposing factors, it is difficult to suspect sternal osteomyelitis with merely symptoms, such as fever or chest pain [ 3 ]. This can lead to a delay in the exact diagnosis of sternal osteomyelitis, finally resulting in sequelae after treatment with inappropriate antibiotics [ 4 ].…”

Causes systémiques ou originales de douleurs thoraciques

“…Des infections manubrio-sternales peuvent se révéler parfois assez brutalement, de même que des ostéites sternales à staphylocoques [41] ou à bacille tuberculeux [42] du sternum, chez des sujets pourtant immunocompétents.…”