Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report

Abstract

BackgroundSeptic arthritis of the sternoclavicular joint (SCJ) is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes.Case presentationA 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2 weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain.ConclusionDiabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.

Spontaneous Bilateral Sternoclavicular Joint Septic Arthritis and Lumbar Discitis: An Unusual Case in a Healthy Adult

“…The combination of unilateral SCSA and discitis has been described in the literature [ 17 – 19 ]. The most common way for spontaneous pyogenic spondylodiscitis to spread is usually hematogenous from infections of the skin, subcutaneous tissues, or urinary tract [ 20 ].…”

A case of hip joint septic arthritis as a complication of a prostate abscess

“…Simultaneously Urologists were consulted. Culture results revealed a Methicillin Susceptible Staphylococcus aureus (MSSA) infection of the joint, a commonly identified pathogen in similar cases [1][2][3][5][6][7][8] . A culture of the prostate confirmed that the infection had spread from the prostatic abscess.…”

“…The patient was informed that the best approach was a surgical debridement but insisted on being treated conservatively for the infection and return home despite understanding the hazards (loss of the joint, severe sepsis and death) 1,3,8 . Therefore, based on antibiogram, intravascular Teicoplanin 1x2 was administered for two weeks 3,6,8 . Following normalization of inflammatory markers the patient was discharged on Ciprofloxacin 500 mg 1x2 for 3 months.…”

“…Although rare, prostatic abscesses can be seen after the age of 60, more often in patients at increased risk. This includes diabetics, immunocompromised, patients on haemodialysis and patients undergoing frequent urinary procedures such as urethral instrumentation or bladder catheterization [1][2][3][4][5][6][7][8] . The commonest identified pathogen is Staphylococcus aureus, while a haematogenous spreading of the infection can result in complications such as sepsis, septic arthritis and osteonecrosis of involved joints [1][2][3][5][6][7][8] .…”

Bel ağrısı ve ateş: omurga enfeksiyonları

“…Nadiren de (%4), retrofarengeal abse veya enfekte aortik graft gibi yakın çevre dokudan da inokülasyon olabilir. [2,3] Granülomatöz omurga enfeksiyonunda en sık karşımıza çıkan etken, Mycobacterium tuberculosis'tir ve Pott absesi olarak da bilinir. En sık omurga metafizine yerleşir ve anterior longitudinal bağ altından kraniyal ve kaudal olarak uzanarak, paravertebral abse formasyonu yapar.…”