Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report

Masmoudi, Karim; Elleuch, E.; Akrout, R.; Feki, A.; Ezzeddine, M.; Fourati, H.; Lahiani, D.; Jemâa, Mounir Ben; Baklouti, S.

doi:10.1186/s13256-018-1709-9

Cited by 3 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Examples include timely treatment of empyema (designated as pyothorax in this study) and ruptured lung abscesses with thoracoscopic versus open pulmonary decortication, pulmonary resection for infarcted or damaged lung, and management of complicated pleural effusions with percutaneous drains and/or thoracostomy tube placement using tPA and DNAse [33][34][35][36][37][38][39][40]. Though not readily identifiable in this database, septic sternoclavicular joint has been associated with intravenous drug use and endocarditis, and we have found this to be not uncommon in our patient population and in need of surgical management [41][42][43]. Anecdotally, we have observed a notable increase in thoracic surgical consults for septic pulmonary emboli, empyema and lung abscesses in patients admitted with IE at our own institution.…”

Section: Plos Onementioning

confidence: 87%

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

et al. 2021

View full text Add to dashboard Cite

Background The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use. Methods Hospitalizations of adult (≥18 years old) patients diagnosed with IE were identified in the 2016 National Inpatient Sample using ICD-10 codes. Multivariable logistic and linear regression were used to compare IE patient outcomes between those with and without pulmonary complications and to identify predictors of pulmonary complications. Interaction terms were used to assess the impact of drug-use IE (DU-IE) and pulmonary complications on inpatient outcomes. Results In 2016, there were an estimated 88,995 hospitalizations of patients diagnosed with IE. Of these hospitalizations,15,490 (17%) were drug-use related. Drug-use IE (DU-IE) had the highest odds of pulmonary complications (OR 2.97, 95% CI 2.50, 3.45). At least one pulmonary complication was identified in 6,580 (7%) of IE patients. DU-IE hospitalizations were more likely to have a diagnosis of pyothorax (3% vs. 1%, p<0.001), lung abscess (3% vs. <1%, p<0.001), and septic pulmonary embolism (27% vs. 2%, p<0.001). Pulmonary complications were associated with longer average lengths of stay (CIE 7.22 days 95% CI 6.11, 8.32), higher hospital charges (CIE 78.51 thousand dollars 95% CI 57.44, 99.57), more frequent post-discharge transfers (acute care: OR 1.37, 95% CI 1.09, 1.71; long-term care: OR 2.19, 95% CI 1.83, 2.61), and increased odds of inpatient mortality (OR 1.81 95% CI 1.39, 2.35). Conclusion and relevance IE with pulmonary complications is associated with worse outcomes. Patients with DU-IE have a particularly high prevalence of pulmonary complications that may require timely thoracic surgical intervention, likely owing to right-sided valve involvement. More research is needed to determine optimal management strategies for complications to improve patient outcomes.

show abstract

Section: Plos Onementioning

confidence: 87%

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Die wissenschaftliche Erstbeschreibung der Pathologie erfolgte im Jahr 1958 durch Arlet und Ficat mit der Publikation zweier Fälle, die mithilfe einer radikalen Resektion erfolgreich zur Ausheilung gebracht werden konnten 1 . In 95% der Fälle tritt die Erkrankung unilateral auf, es existieren allerdings auch Fallbeschreibungen über bilaterale Infektionen 2 , 3 . Am häufigsten kann im Rahmen mikrobiologischer Untersuchungen Staphylococcus aureus als ursächlicher Erreger isoliert werden.…”

Section: Introductionunclassified

“…Arlet and Ficat presented the first scientific pathology report in 1958 with their publication of two cases which were successfully treated and cured by radical resection [1]. The disorder presents unilaterally in 95 % of cases, although there are also case reports of bilateral infections [2,3]. Microbiological examinations most commonly isolate staphylococcus aureus as the causal organism.…”

Section: Introductionmentioning

confidence: 99%

“…Nach Kenntnis der Autoren wurde dieses chirurgische Vorgehen bis dato in der Literatur noch nicht beschrie- [1]. In 95 % der Fälle tritt die Erkrankung unilateral auf, es existieren allerdings auch Fallbeschreibungen über bilaterale Infektionen [2,3]. Am häufigsten kann im Rahmen mikrobiologischer Untersuchungen Staphylococcus aureus als ursächlicher Erreger isoliert werden.…”

unclassified

See 1 more Smart Citation

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

et al. 2020

View full text Add to dashboard Cite

Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 – 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. Patient and Method According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the “figure of eight” technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. Results and Conclusion One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authorsʼ knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.

show abstract

“…is paramount. SCJI are mostly unilateral (95%), with the majority occurring on the right side (60%) (17). This difference in laterality becomes less apparent in IV drug users (18).…”

Section: Medical History and Physical Exammentioning

confidence: 99%

Diagnosis and management of sternoclavicular joint infections: a literature review

2020

View full text Add to dashboard Cite

The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.

show abstract

Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report

Cited by 3 publications

References 11 publications

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

Diagnosis and management of sternoclavicular joint infections: a literature review

Contact Info

Product

Resources

About