Breast Abscess: A Unique Presentation as Primary Septic Arthritis of the Sternoclavicular Joint

Dhulkotia, Amit; Asumu, T.; Solomon, Patricia

doi:10.1111/j.1075-122x.2005.00170.x

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…14 Abscesses may migrate and infect the surrounding soft tissues. 15,16 Mediastinitis is the most serious complication but occurs in less than 15% of cases. Osteomyelitis of the sternum or the clavicle is one of the most common complications of SC joint arthritis, occurring in more than 50% of cases.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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Septic arthritis is a medical emergency that requires immediate action to prevent significant morbidity and mortality. The sternoclavicular joint may have a more insidious onset than septic arthritis at other sites. A high index of suspicion and judicious use of laboratory and radiologic evaluation can help solidify this diagnosis. The sternoclavicular joint is likely to become infected in the immunocompromised patient or the patient who uses intravenous drugs, but sternoclavicular joint arthritis in the former is uncommon. This case series describes the course of 2 immunocompetent patients who were treated conservatively for septic arthritis of the sternoclavicular joint. Case 1A 50-year-old man presented to his primary care physician with a 1-week history of nausea, vomiting, and diarrhea. His medical history was significant for 1 episode of pseudo-gout. He had no chronic medical illnesses. He was noted to have a heart rate of 60 beats per minute and a blood pressure of 94/58 mm Hg. His heart rate increased to 72 beats per minute while seated. He had presumed gastroenteritis. He was given 2 L intravenous 0.9% normal saline in the outpatient setting, with an increase in blood pressure to 100/68 mm Hg. He was seen 2 days later and was beginning to feel better but had a new complaint of tenderness at the left sternum. The patient began a 5-day course of prednisone. Blood was collected at this time. The next day, blood analysis revealed a critical laboratory value for creatine phosphokinase level of 9005 U/L and an erythrocyte sedimentation rate of 120 mm/hour. The patient was asked to go to the hospital to receive further evaluation. At the time of admission, he continued to complain of left clavicular pain, and the course of prednisone failed to provide any pain relief. The patient denied any current fevers or chills. He was afebrile, and examination revealed a swollen and tender left sternoclavicular (SC) joint. The prostate was normal in size and texture and was not tender during palpation. Laboratory analysis showed a white blood cell count of 19.3 thousand/microliter, with 92% segmented neutrophils and no bands (Table 1). Urinalysis was significant for blood and leukocyte esterase. Blood and urine cultures were obtained. A radiograph of the clavicle was normal. The patient was started on intravenous fluids for the elevated creatine phosphokinase level. Ceftriaxone (1 g intravenous daily) was started for the leukocytosis, pyuria, and history of fever. On hospital day 1, blood and urine cultures yielded Gram-negative bacilli that were later identified as Escherichia coli. It was believed that the E. coli bacteremia seeded the SC joint, leading to septic arthritis. A computed tomography (CT) scan of the sternum was performed to assist with diagnosis and showed no fluid in the SC joint and no sign of bony erosion or sclerosis at the manubrium or medial end of the clavicle. The antibiotic was changed to intravenous ciprofloxacin for better tissue penetration of the urinary tract because the prostate was a concer...

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Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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“…This pattern of pain can mimic a myocardial Infarction. Other unusual presentations include vocal cord palsy (20), dysphagia (21), cervical esophageal rupture (22), lower respiratory infection (23), breast abscess (24) and subclavian compression syndrome (25).…”

Section: Medical History and Physical Exammentioning

confidence: 99%

Diagnosis and management of sternoclavicular joint infections: a literature review

2020

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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.

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“…Sternoclavicular joint (SCJ) osteomyelitis is an infection of the joint where the clavicle attaches to the manubrium and is usually associated with an abscess in the area. It is a very rare condition with approximately 225 cases reported in the past 45 years [ 1 – 21 ]. All of the patients reported in the literature were treated with antibiotics initially and some patients underwent surgical management of sternoclavicular joint osteomyelitis when symptoms did not improve on antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Sternoclavicular Joint Osteomyelitis with Debridement and Delayed Resection with Muscle Flap Coverage Improves Outcomes

Muesse

Blackmon

Ellsworth

et al. 2014

Surgery Research and Practice

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The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis.

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Breast Abscess: A Unique Presentation as Primary Septic Arthritis of the Sternoclavicular Joint

Cited by 5 publications

References 9 publications

Septic Arthritis of the Sternoclavicular Joint

Septic Arthritis of the Sternoclavicular Joint

Diagnosis and management of sternoclavicular joint infections: a literature review

Treatment of Sternoclavicular Joint Osteomyelitis with Debridement and Delayed Resection with Muscle Flap Coverage Improves Outcomes

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