Primary sternal osteomyelitis.

Abstract

Primary osteomyelitis of' the sternum is a rare condition. Infection may follow chest trauma and is a recognised complication of open heart surgery, with a reported incidence of 1-2%.' Since the detailed review by Wilensky and Samuels in 19262 there have' been only occasional reports. We describe a case of chronic sternal infection without preceding trauma and present a review of published reports. Case reportA 40 year old housewife presented with pain and swelling in the front of her chest five months after an acute self limiting diarrhoeal illness in Tenerife. The swelling had developed over five days and was associated with weight loss of 6.3 kg. Examination revealed an inflammed tender area over the manubrium measuring 3 x 2 cm and pyrexia of 37.40C. There was no lymphadenopathy and no other focus of infection was found. Radiographs showed widening of the sternum without lysis. The white cell count was 11.3 x 109/l; the initial erythrocyte sedimentation rate was 65 Westergren units in one hour, rising to 115 over the next week. Needle aspiration of the sternum showed scanty Gram negative micrococci, considered to be contaminants. Blood, stool, urine, and marrow cultures were negative and serological examination for brucella and typhoid organisms also gave negative results. Culture for acid fast bacilli was negative. A needle biopsy of the sternum was performed and histological examination showed features of chronic non-specific inflammation with reactive woven bone formation, but no organisms were seen. A gallium bone scan (figure), which has been of diagnostic value in previous cases,3 showed increased uptake along the sternum suggestive of osteomyelitis and treatment was started with fusidicacid on the assumption that Staphlococcus aureus was the most likely pathogen. There was no improvement in her condition after one month so treatment was discontinued and surgical exploration of the sternum was undertaken. Material obtained showed microscopic features of chronic inflammation. The curettings obtained did not contain pus and again no organisms were identified. Doxycycline was prescribed. Symptomatic relief was gradually achieved, the signs resolved, and the patient remains well several months later.

Tuberculous osteomyelitis of the sternum in an infant: A case report and review of the literature

“…Primary osetomyelitis of the sternum of any etiology is rarely encountered in childhood. We were only able to identify six cases in English literature since 1910 4−7 . The causative organism was Staphlococcus aureus in two cases, 4,7 gram‐negative coccobacillus in one case 6 and not identified in the other three 5 .…”

Primary Sternal Osteomyelitis caused byStaphylococcus aureusin an Immunocompetent Adult

“…PSO typically occurs secondary to predisposing factors, such as immunodeficiency, intravenous drug abuse, subclavian vein catheterization, or liver cirrhosis [ 2 ]. The most common bacterial cause of PSO is S. aureus , although Pseudomonas aeruginosa is predominant among intravenous drug abusers [ 7 8 ]. Salmonella typhi , S. epidermidis, Nocardia nova , Mycobacterium tuberculosis, and even Aspergillus spp.…”

Sternal osteomyelitis caused by Aspergillus fumigatus in a patient with previously treated Hodgkin's disease

“…The most common organisms are Staphylococcus aureus, Gram negative organisms, and mycobacteria. 2 Aspergillus predominantly causes osteomyelitis in the immunocompromised 3 ; however, it was first recognised as a cause of sternal osteomyelitis in patients who had undergone sternal surgery as part of a cardiothoracic procedure. 4 Such an insidious history is typical, but in most cases presentation is within months of surgery, and also in the context of sternal manipulation and wiring.…”