Septic Arthritis Of Sternoclavicular Joint Research Articles

A challenging case of severe bilateral septic arthritis with osteomyelitis of the sternoclavicular joint in a patient with end-stage renal disease.

Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition that comprises <1% of all joint infections. We report a case of severe bilateral septic arthritis of the SCJ in a patient with end-stage renal disease on peritoneal dialysis. A 44-year-old female presented with right SCJ infection 1 month after recovering from a tenckhoff catheter exit-site infection. She completed 6 weeks of antibiotics however this progressed to bilateral SCJ septic arthritis with osteomyelitis necessitating multiple surgical debridement and excision of bilateral clavicular heads. Further imaging showed signs of renal osteodystrophy and degenerative joint changes resembling calcium pyrophosphate deposition. Patients with end-stage renal disease have multiple risk factors including immune system dysfunction, renal osteodystrophy and dialysis access sites that increase susceptibility to bacteraemia and seeding. Therefore in such patients, prompt assessment is necessary to ensure expeditious diagnosis and treatment of this potentially debilitating condition. A multidisciplinary team involving various specialties is crucial for the holistic care for such patients and to reduce the risk of recurrence.

Septic Arthritis of the Sternoclavicular Joint.

Sternoclavicular joint (SCJ) septic arthritis is a rare but rapidly fatal joint infection. Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis, or myositis. A 57-year-old male with a past history of intravenous drug use presented to the emergency department (ED) with chest tenderness of one week duration. Vital signs were unremarkable, and exam was notable for tender, raised right SCJ without any fluctuance. On point-of-care ultrasound we noted fluid collection and capsular distention along the SCJ, which aided in rapidly diagnosing septic arthritis. The patient was immediately started on antibiotics and taken to the operating room for excision and debridement. While computed tomography is routinely used in the emergency department for diagnosing septic arthritis, ultrasound offers a rapid and safe alternative for diagnosis.

Mycobacterium Bovis Sternoclavicular Joint Septic Arthritis in Patient on Avelumab for Metastatic Urothelial Cell Carcinoma

Mycobacterium Bovis Sternoclavicular Joint Septic Arthritis in Patient on Avelumab for Metastatic Urothelial Cell Carcinoma

Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report

The sternoclavicular joint (SCJ) is an uncommon location for septic arthritis to occur in. Due to the rarity of the condition and the nonspecific symptoms, SCJ septic arthritis can be missed or mislabeled as osteoarthritis or muscle strain. Accurate history and physical examination is crucial for recognizing this condition. With the potential life-threatening complications that may ensue, SCJ septic arthritis has traditionally been managed surgically. This ranges from simple incision and drainage to resection of the joint. However, in cases where there is not enough fluid for incision and drainage, a trial of medical management with antibiotics can be attempted. We herein describe a case of a 58-year-old male who presented with nonspecific anterior chest wall and neck pain. Chest X-ray and ultrasound of the anterior chest wall was normal; however, magnetic resonance imaging (MRI) of the chest showed a small effusion without other complications. His blood cultures grew extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, rendering this as his hematogenous source of septic arthritis. The ESBL was from a left-sided obstructing kidney stone that resulted in pyelonephritis, which was confirmed via computed tomography of the abdomen. His effusion was too minimal to drain; therefore, he was managed medically with intravenous (IV) antibiotics along with a left ureteral stent placement, and he had a full recovery. This case represents the ability for SCJ septic arthritis to be managed medically with IV antibiotics, especially when the diagnosis is caught early without complications. The role of MRI is indispensable for coming to the diagnosis, as it is capable of detecting complications that ultimately dictate management. Additionally, this case highlights the unique microorganism, ESBL-producing E. coli causing the SCJ septic arthritis, a finding that has been rarely reported in the literature as the majority of microorganisms that have been previously documented are either Staphylococcus aureus or Pseudomonas aeruginosa.

Increasing Incidence of Sternoclavicular Joint Infections in Intravenous Drug Users.

Sternoclavicular joint septic arthritis is rarely seen in the general population. The majority of cases are seen in intravenous drug users. Given the lack of reported cases in the literature, there is no standardized treatment algorithm for this disease. Described treatment methods range from medical management to wide local debridement. The incidence of sternoclavicular joint septic arthritis will likely continue to increase with rising usage of intravenous drugs in the United States. Within the past year, our institution treated four cases.

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

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 &amp; 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.

Two cases of septic arthritis of sternoclavicular joint with pleural empyema

Two cases of septic arthritis of sternoclavicular joint with pleural empyema

R03 Medical and Conservative Surgical Management of Bacterial Sternoclavicular Joint Septic Arthritis

Sternoclavicular joint septic arthritis(SCJ SA) is a rare infectious disease process with reported life-threatening complications such as mediastinal abscess and mediastinitis. The available literature reports variable success of medical management and a predominance of surgical management, with a 58% rate of surgical washout/debridement and high rates (47%) of resection of the sternoclavicular joint and medial third of the clavicle.

Muscle flaps for sternoclavicular joint septic arthritis

Septic arthritis of the sternoclavicular joint (SC) is rare. The most accepted technique for reconstruction of the defect after SC joint resection is the use of muscle flaps. We hypothesized that resection of ribs with the SC joint impacts timing, type and outcomes of reconstruction. This is a retrospective review of 44 patients who underwent wound closure with muscle flap following resection of the SC joint for septic arthritis over 14 years period from a single institution. Patients were divided into two groups based on the resection of the adjacent ribs with the SC joint. We found 18 (40.9%) patients with SC joint resection only and 26 (59.1%) with concomitant resection of the adjacent ribs. Patients in the rib resection group were younger, did not need SC joint fluid aspiration, and had higher tissue culture positivity (p < .05). Rib resection with the SC joint was found to be associated with delayed reconstruction (57.7% vs 22.2%, p = .030), need for serial debridement’s (2 vs 1, p = .009), increased days from debridement to reconstruction for a subset of patients (75% percentile of 8 days vs. 0 days, p = .024), and longer hospital stay (18 vs 9, p = .006). Flap complications were higher in rib resection group (26.9% vs 5.6%, p = .67). Reconstruction following resection of the SC joint for septic arthritis is guided by the surgeon's impression regarding source control of infection. Rib resection concomitantly with joint resection appears to be a useful indicator of disease extent and may help guide clinical decision making in this challenging scenario.

Medical and conservative surgical management of bacterial sternoclavicular joint septic arthritis: a case series.

Sternoclavicular joint septic arthritis (SCJ SA) is a rare infectious disease process with reported life-threatening complications such as mediastinal abscess and mediastinitis. The available literature reports variable success of medical management and a predominance of surgical management, with a 58% rate of surgical washout/debridement and high rates (47%) of resection of the SCJ and medial third of the clavicle. A retrospective case series of radiologically or microbiologically confirmed cases of bacterial SCJ SA at Fiona Stanley Hospital was analysed. Demographic data, investigations, management and outcomes were assessed. Eleven cases of bacterial SCJ SA were identified. Eight cases were of primary SCJ SA, whilst three cases were secondary to haematogenous seeding. Recognized risk factors such as intravenous drug use, diabetes mellitus, trauma, smoking and immunosuppression were present. The most common complication was clavicular osteomyelitis (64%). Life-threatening complications included mediastinal abscess and rapidly progressive necrotizing myositis. Nine patients (82%) were managed with primary medical therapy, with two patients failing antibiotic therapy and requiring joint washout. Two patients were taken for urgent washout on presentation. Four cases (36%) resulted in operative SCJ washout. There were no cases requiring resection of the SCJ or clavicle. This series suggests that SCJ SA can be primarily treated medically in the absence of life-threatening complications. In addition, medical management may be sufficient for cases complicated by clavicular osteomyelitis. Need for surgical resection of the SCJ and medial third of the clavicle may be less than previously reported.

Septic Arthritis of Sternoclavicular Joint with Multiple Abscesses : A Case Report

Septic Arthritis of Sternoclavicular Joint with Multiple Abscesses : A Case Report

A CASE OF MEDIASTINITS AND SEPTIC THROMBOPHLEBITIS SECONDARY TO SEPTIC STERNOCLAVICULAR JOINT ARTHRITIS

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Septic Sternoclavicular joint (SCJ) is a rare diagnosis. Certain risk factors such as diabetes mellitus have been associated with it. The most serious complication of this condition is mediastinits. CASE PRESENTATION: A 48-year-old male with history of type II diabetes mellitus presented with complaints of a progressively worsening left parasternal discomfort that started 3 days ago, which worsened with movement. He also described subjective fever, chills and diaphoresis at home. He denied upper respiratory symptoms. He has had no recent surgeries or instrumentation. He travelled recently to a but denied sick contacts. On presentation he was febrile, tachycardic, diaphoretic, hypertensive. His labs showed leukocytosis to 32000/mm3, a sodium level of 124 and elevated glucose of 484. On physical examination the patient had reproducible left shoulder and chest wall tenderness with palpation. Levaquin 750 mg intravenously was initiated along with supportive therapy. Computed Tomography (CT) of the chest showed anterior mediastinal fat infiltration consistent with mediastinitis and left sided pleural effusion. CT head and neck was ordered which showed inflammatory changes at the left thoracic inlet with involvement of adjacent mediastinal fat, with nonopacification of left subclavian vein and left innominate vein, suspicious for septic phlebitis and adjacent mediastinitis. Blood cultures grew methicillin-sensitive staphylococci. The patient was then started on cefazolin intravenously. Follow up blood cultures cleared and he was discharged on intravenous cefazolin for 4 weeks and outpatient follow up. DISCUSSION: SJC infection is rare occurring only about 0.5-1% of all infections [1]. Common causes include diabetes mellitus, intravenous drug use, trauma, immunosuppression, infected central lines among others. The clinical signs of SCJ septic arthritis are chest pain localizing to the SCJ (78 %), fever (65 %), and shoulder pain (24 %) and neck pain (2%) [1,2]. Joint swelling and overlying erythema is common. A CT scan of the chest or magnetic resonance imaging is recommended as the initial imaging study that helps identify bone destruction, however the final diagnosis is made from culture of the joint fluid obtained using needle aspiration or open biopsy. Common organisms that has been described are staphylococcus aureus coli, H influenza, Streptococcus pneumonia, streptococcus pyogenes [1,2]. The most potential and serious complication is mediastinitis, which occurs in less than 15% of cases [1,2] as in our case. Our case is unique because it also lead to septic thrombophelibitis of left subclavian vein. Antibiotics with or without drainage and surgical debridement is the treatment of choice. CONCLUSIONS: Sternoclavicular joint septic arthritis is a rare condition. Anterior mediastinitis and septic thrombophlebitis should be suspected as possible complications in uncontrolled diabetes. Reference #1: Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). 2004;83(3):139-48. Reference #2: 2. Yood RA, Goldenberg DL. Sternoclavicular joint arthritis. Arthritis Rheum. 1980;23:232–9. DISCLOSURES: No relevant relationships by Janak Adhikari, source=Web Response No relevant relationships by Karim Anis, source=Web Response No relevant relationships by AHMET HAKKI KAPICI, source=Web Response No relevant relationships by Fnu Zafrullah, source=Web Response

A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female

BackgroundAustrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.Case presentationA case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy.ConclusionsClinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.

Sternoclavicular joint septic arthritis and osteomyelitis

Septic arthritis is an emergency condition in orthopedics because any delay in diagnosis and treatment can lead to the development of osteomyelitis and permanent damage to the bones and articulating surfaces. Septic arthritis of the sternoclavicular joint (SCJ) is an especially unusual infection and can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. Early diagnosis and prompt management are keys for avoiding the development of untoward complications. The aim of this report is to present our management of a case with no well-known cause for the presence of infection in SCJ and to compare the findings to the literature. This case report describes the course of a patient with medical comorbidities (hypertension, ischemic heart disease, and diabetes mellitus) who was managed surgically for SCJ septic arthritis.

Internal Jugular Vein Thrombosis Mimicking Sternoclavicular Joint Septic ArthritisA Rare Case Report

Internal jugular vein thrombosis is a vascular disease occurring spontaneously. Some of the predisposing factors include trauma, intravenous catheterization and deep neck infections. It is important to an orthopaedician, as it mimics sternoclavicular joint septic arthritis very closely. This can lead to wrong decision in opting for surgical drainage of the abscess which may turn out to be disastrous to the patient. Our case report describes a patient who presented to the emergency room with pain, swelling and redness over the sternoclavicular joint. Initial evaluation suggested septic arthritis of left sternoclavicular joint. On further evaluation this was ruled out and finally diagnosed as internal jugular vein thrombosis with adhesive capsulitis of left shoulder.

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SESSION TITLE: Critical Care 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Streptococcus Agalactiae, also known as Group B Streptococcus (GBS) is a gram-positive bacteria that has been increasingly recognized to cause a broad spectrum of infections in the non pregnant adult population. GBS is considered to be a part of the human microbiota that colonizes the genitourinary and gastrointestinal tract, S.Agalactiae can also cause severe invasive infections in adults. We report a case of acute descending mediastinitis as a complication of septic arthritis of the sternoclavicular (SC) joint due to hematogenous spread of S.Agalactiae in a patient with a rectovaginal fistula and a presacral abscess. CASE PRESENTATION: 50 year old female with recurrent stage IV rectal adenocarcinoma who is status post extensive tumor resection including low anterior resection with end colostomy, complicated by formation of a rectovaginal fistula, who presented with a new presacral stump abscess, urinary tract infection, Streptococcus Agalactiae bacteremia and clinical and radiographic evidence of right sternoclavicular joint septic arthritis, osteomyelitis of clavicle and multiple abscesses superior and posterior to the SC joint with enhancement extending to the superior mediastinum on chest MRI. Patient was adequately resuscitated and started on antibiotics. She was immediately taken to the operating room (OR) for immediate debridement and washout of chest wall abscesses and resection of the right sternoclavicular joint and partial right clavicle, and first rib and manubrium ostectomy. OR tissue cultures grew S.Agalactiae. She proceeded to have presacral abscess drained, which also grew S. Agalactiae. Patient performed well and was later discharged home to complete her 6 week course of antibiotics. DISCUSSION: Acute descending mediastinitis is a life threatening condition that carries high mortality if not recognized promptly. To our knowledge, two case reports in the current literature have described GBS as a cause of mediastinitis. It has been described as a late complication of abortion and a deep neck abscess. Diabetes has been hypothesized as a risk factor for severe GBS infection. In our patient, the presence of a rectovaginal fistula allowed the translocation of S.Agalactiae from the genitourinary tract in the pelvis. We suspect that the presacral stump abscess was the source of her GBS bacteremia which lead to septic arthritis of her right SC joint, osteomyelitis of the right clavicle and progressed to acute descending mediastinitis. The rarity of this association and the unexpected microbiologic nature of the patient’s mediastinitis prompted this report. CONCLUSIONS: Patients with rectovaginal fistulae may be at increased risk of Group B Streptococcus translocation to the pelvis, which may cause hematogenous spread and further invasive infections. Reference #1: Rapp C, Debord T, Breton G, Imbert P, Roué R. [Streptococcus agalactiae mediastinitis, a late complication of abortion]. Presse Med. 2002;31(16):744. Reference #2: Yoshii Y, Shimizu K, Watanabe S, Takagi M, Kuwano K. [A case of descending necrotizing mediastinitis caused by infection with Streptococcus agalactiae in a patient with diabetes mellitus]. Kansenshogaku Zasshi. 2012;86(6):768-72. Reference #3: Kuhtin O, Schmidt-rohlfing B, Dittrich M, Lampl L, Hohls M, Haas V. [Treatment Strategies for Septic Arthritis of the Sternoclavicular Joint]. Zentralbl Chir. 2015;140 Suppl 1:S16-21. DISCLOSURES: No relevant relationships by christina al malouf, source=Web Response No relevant relationships by Martine Al Malouf, source=Web Response No relevant relationships by Xavier Jimenez, source=Web Response

Surgical management of sternoclavicular joint septic arthritis

IntroductionInfections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. Patients and methodsWe retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). ResultsNine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. ConclusionCT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.

Sternoclavicular Joint (SCJ) Septic Arthritis Presenting as Excruciating Cervical and Chest Pain With Intractable Hiccups

SESSION TITLE: Bacterial Infections 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: The SCJ is an unusual site of septic arthritis. It is involved in 0.5-1.0% of all joint infections and <0.5% of joint infections in healthy patients. The clinical signs of SCJ septic arthritis are chest pain localizing to SCJ (78%), fever (65%), and shoulder pain (24%). Here we present a case of SCJ septic arthritis with chest pain and intractable hiccup. CASE PRESENTATION: A 72-yo man, fell 1 month ago, was admitted for bacteremia. He was recently treated for pneumonia (PNA). Patient endorsed 3-day right-sided chest pain radiating from distal sternal border toward neck, with 2-day intractable hiccups. Patient had tender cervical/supraclavicular fullness with limited range of glenohumeral joint movement. WBC 17,300/uL with left shift. CXR showed right lower lobe (RLL) opacity. Rocephin and doxycycline were started. Given recent fall, chest pain, intractable hiccup, neck fullness, CT neck/soft tissue was order to evaluate for fracture, dislocation, subcutaneous emphysema, infection, or referred pain from diaphragmatic/pericardial pleural irritation in setting of RLL PNA. CT showed soft tissue infiltration centered in the right sternoclavicular region which extends inferiorly into the anterior mediastinum. There is superior extension along the right lateral anterior border of the thyroid, deep to the sternocleidomastoid. Infiltrated/inflamed fat interdigitates between the carotid artery and the thyroid on the right. The findings were most consistent with septic right SCJ, cellulitis/myositis of the right sternocleidomastoid, and phlegmon extending into the anterior mediastinum. ESR 72 mm/hr, CRP 248.3 mg/L. Blood cultures grew S. aureus. He was treated with 6-week rocephin. There was no indication for acute surgical intervention. On follow up, WBC 5500/uL, ESR 51 mm/hr, CRP 40.6 mg/L. DISCUSSION: Common risk factors for SCJ septic arthritis include IVDU (21%), infection at distant site (15%), diabetes mellitus (13%), trauma (12%), and infected central venous line (9%). No risk factors were found in 23% of patients with SCJ septic arthritis. The route of infection is often unknown. Management of SCJ septic arthritis consists of surgical debridement and IV antibiotics. The rate of positive cultures with needle aspiration is 77%, surgical debridement 36%, and blood cultures 13%. Typical causative organisms: S. aureus (49%), P. aeruginosa (10%), Brucella melitenis (7%), E. coli (5%), less frequently M. tuberculosis. CONCLUSIONS: SCJ septic arthritis may lead to serious complications such as osteomyelitis, chest wall abscess, mediastinitis, myositis, with irreversible tissue damage. Prompt diagnosis and appropriate surgical and antibacterial treatments are required. Clinical signs/symptoms and physical exam remain the core components to help in diagnosis with the support of imaging. Reference #1: Yoshihito Tanaka et al. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. Journal of Medical Case Reports (2016) 10:69. DISCLOSURE: The following authors have nothing to disclose: Kim Phung Nguyen, Vandana Pai No Product/Research Disclosure Information

Clinical manifestations, treatment outcomes, and risk factors for sternoclavicular septic arthritis.

Septic arthritis of the sternoclavicular joint (SCJ) is an atypical and rarely seen clinical condition. The prognosis for patients with SCJ septic arthritis is often poor. The objective of this study was to compare clinical characteristics between SCJ and non-sternoclavicular joint (NSCJ) septic arthritis and to identify independent risk factors for SCJ septic arthritis. A total of 450 adult patients diagnosed with septic arthritis during the January 2002 to December 2013 study period were included in this retrospective cohort study. Patient characteristics, clinical manifestations, and treatment outcomes were examined. Univariate and multivariate analysis was performed to identify potential risk factors for SCJ septic arthritis. Thirty-three (7.3%) of 450 patients had SCJ septic arthritis and the remaining 417 patients had NSCJ. Oligoarthritis or polyarthritis were seen more often in SCJ patients than in NSCJ patients (55 vs. 19%; p < 0.05). Abscess formation and bacteremia were more commonly found at presentation in the SCJ group than in the NSCJ group (18 vs. 8%; p < 0.05 for abscess formation; and, 53.1 vs. 26.6%; p < 0.05 for bacteremia). In multivariate analysis, extra-articular infection (OR 2.7, 95% CI 1.2-6.4; p = 0.02), cirrhosis (OR 1.9, 95% CI 1.1-3.3; p = 0.02), and malignancy (OR 3, 95% CI 1.1-7.8; p = 0.03) were independent risk factors for SCJ septic arthritis. SCJ septic arthritis is an uncommon septic arthritis that frequently presents with local and systemic complications. Factors found to be significantly associated with SCJ septic arthritis were extra-articular infection and immunocompromised host. A high index of suspicion in high-risk patients is the key to achieving improved outcomes.

A geriatric patient with sternoclavicular, first costosternal septic arthritis and pyogenic pectoral myositis

Septic arthritis is the suppurative inflammation of the joints that is usually caused by bacteria. It is a medical emergency that should be rapidly diagnosed and treated appropriately for optimized prognosis. Staphylococcus aureus is the most common isolated bacterial pathogen; knee, hip, and shoulder joints are the most commonly affected sites by infection [1]. The prevalence of bacterial arthritis among adults has been estimated to range between 8–27% [2,3]. However, sternoclavicular joint septic arthritis is a rare condition. In this case report, a geriatric female patient diagnosed with sternoclavicular, first costosternal joint septic arthritis accompanied by pyogenic myositis will be presented.