Abstract
Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.
Highlights
Primary arthritis of chondrosternal joint in infants should always be considered in the differential diagnosis when a child presents with a parasternal mass with history of fever and/or local signs of infection
Ultrasound was performed for the early diagnosis and for the follow-up of the chondrosternal arthritis
The most common microorganism found in osteoarticular infections is Staphylococcus aureus, while Streptococcus pneumoniae and Kingella kingae are found in infants especially between the ages of 2 months and 5 years [3, 7, 8]
Summary
Primary arthritis of chondrosternal joint in infants should always be considered in the differential diagnosis when a child presents with a parasternal mass with history of fever and/or local signs of infection. As it is a very rare infection, adequate diagnosis is often delayed. The differential diagnosis includes systemic arthritis, osteomyelitis, Tietze syndrome, and SAPHO syndrome [1, 2]. Clinical symptoms may vary from a painless noninflammatory to a painful mass with local tenderness and swelling. Low or high levels of white blood cells (WBC) and C-reactive protein (CRP) may be present, reflecting, respectively, the subacute or acute character of the infection
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