頸部郭清術後に生じた化膿性胸鎖関節炎の1例

Abstract

We report a case of pyogenic arthritis of the sternoclavicular joint after neck dissection. An 81-year-oldman was referred to our department because of pain in the right sternoclavicular joint on moving the right upper limb in 2007.In 2003, a malignant tumor of the floor of the mouth with bilateral lymph node metastasis was diagnosed. He received preoperative chemotherapy and underwent resection of the malignant tumor in the floor of the mouth, right total neck dissection, and left functional neck dissection. In addition, he received a total of 63 Gy of radiotherapy. After these treatments, there was no sign of tumor recurrence or distant metastasis. However, in June 2007, the patient had pyrexia, tenderness and swelling of the right sternoclavicular joint, and pain in the joint on moving the right upper limb. CT revealed an abscess in the sternoclavicular joint, and pyogenic arthritis of the sternoclavicular joint was diagnosed by an orthopedist. The right sternoclavicular joint was punctured, but the pus could not be removed. He then received antibiotic therapy. Tenderness and swelling of the right sternoclavicular joint disappeared, and pain in the right sternoclavicular joint also resolved.Three months later, the patient visited us again with similar symptoms of the left sternoclavicular joint. Pyogenic arthritis of the left sternoclavicular joint was diagnosed by an orthopedist, and he was given antibiotic therapy again. Subsequently, the symptoms gradually resolved. The patient is being followed up in our outpatient clinic. No recurrence of pyogenic arthritis of the sternoclavicular joint has occurred until now.