Diagnostic Dilemma of Anaerobic septic arthritis of Sternoclavicular joint in a previously healthy patient: A case report

Abstract

We came across a 30 year old healthy female patient with severe pain and swelling over the left sternoclavicular joint for three weeks, without any history of trauma. Patient was evaluated elsewhere and empirically started on Antitubercular drugs. Patient was admitted and evaluated as per pain was unpropotionate to her complaints. Computerised Tomography scan revealed eroded medial end of the left clavicle. Magnetic Resonance Imaging scan showed hyper intensity along the sternocleidomastoid and collection in anterior mediastinum. Erythrocyte sedimentation rate and Creactive protein on admission was 120 and 98 respectively. Patient underwent decompressioof the left sternoclavicular joint with resection of the medial end of clavicle and excision of the sinus. Anaerobic culture showed growth of bacteroids. Patient was started on Clindamycin and Metronidazole for six weeks. Patient was symptomatically better. Repeat ESR and CRP was 20 and five at the end of six weeks. We suggest that decompression with appropriate antibiotics should be considered at the earliest in sternoclavicular arthritis.