Sternoclavicular joint septic arthritis manifesting as deep neck infection in patients with recent acupuncture history and intra-articular injection

Abstract

Abstract Introduction: Septic arthritis in sternoclavicular joint (SCJ) with neck abscesses is very rare. Acupuncture and intra-articular injections have been reported as a cause of septic arthritis. Patient concerns: Two patients, one with a history of acupuncture and the other with a history of intra-articular injection complained of fever and neck abscess arising as a complication of SCJ septic arthritis. Diagnosis: Computed tomography revealed abscesses in the upper chest wall, retrosternum, anterior mediastinum, lower portion of the neck, and SCJ area. Interventions: Surgical drainage was performed successfully for both patients. The tissues from the SCJ, proximal clavicle, and deep cervical fascia showed chronic active inflammation without granulomas, accompanied with joint arthritis and osteomyelitis. In the abscesses, methicillin-resistant & sensitive Staphylococcus aureus was isolated. Empirical antibiotic treatment covering these organisms was administered to these patients. Outcomes: Following the surgical drainage, the hospital stay was free of complications and there was no recurrence of SCJ arthritis at 6 months follow-up. Conclusion: Neck abscesses in patients with a recent acupuncture or intra-articular injection may develop due to SCJ septic arthritis. If SCJ septic arthritis is not detected early, fatal complications can occur. Therefore, awareness of such an atypical presentation is essential for prompt diagnosis and appropriate management.