Septic arthritis in an unusual localization

Abstract

Septic arthritis is a rheumatological emergency due to its potential for rapid articular destruction and permanent functional loss. Its incidence ranges between 4 and 29 cases per 100,000 person-years, and depends on population variables and preexisting structural joint abnormalities. Clinical manifestations, severity, treatment and prognosis depend on the aetiologic agent, patient basal status and articulation involved. The sternoclavicular and condrosternal articulations are rarely affected. A 24 years old man presented with fever and right shoulder pain. Physical examination revealed swelling, redness, increased local heat, intense pain and functional impairment of the patient’s right shoulder. Laboratory inflammatory markers were elevated. Right sternoclavicular articulation ultrasound, right sternoclavicular articulation X-ray, and galium bone scan have shown sternoclavicular arthritis and medial clavicular osteomyelitis. Blood cultures identified Staphylococcus aureus methicillin sensitive. The patient completed a six week antibiotic regimen and physical rehabilitation program. Herein, the authors report a case of sternoclavicular septic arthritis complicated with osteomyelitis and review aetiology, diagnosis, treatment and prognosis of this rare medical condition.

Share and Cite:

Marques, L. , Simões, A. and Úria, S. (2013) Septic arthritis in an unusual localization. Case Reports in Clinical Medicine, 2, 328-331. doi: 10.4236/crcm.2013.25088.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Kaandorp, C.J., Van Schaardenburg, D., Krijnen, P., et al. (1995) Risk factors for septic arthritis in patients with joint disease: A prospective study. Arthritis & Rheumatism, 38, 1819-1825. doi:10.1002/art.1780381215
[2] Geirsson, A.J., Statkevicius, S. and Vikingsson, A. (2008) Septic arthritis in Iceland 1990-2002: Increasing incidence due to iatrogenic infections. Annals of the Rheumatic Diseases, 67, 638-643. doi:10.1136/ard.2007.077131
[3] Horowitz, D.L., Katzap, E., Horowitz, S. and Barilla-LaBarca, M.-L. (2011) Approach to septic arthritis. American Family Physician, 84, 653-660.
[4] Cook, P.P. and Siraj, D.S. (2012) Bacterial arthritis. Firestein: Kelley’s textbook of rheumatology. 9th Edition, Elsevier, Saunders, Philadelphia.
[5] Goldenberg, D.L. (1998) Septic arthritis. Lancet, 351, 197-202. doi:10.1016/S0140-6736(97)09522-6
[6] Smith, J.W. and Piercy, E.A. (1995) Infectious arthritis. Clinical Infectious Diseases, 20, 225-230. doi:10.1093/clinids/20.2.225
[7] Epstein, J.H., Zimmermann III, B. and Ho Jr., G. (1986) Polyarticular septic arthritis. Journal of Rheumatology, 13, 1105-1107.
[8] Ross, J.J. and Shamsuddin, H. (2004) Sternoclavicular septic arthritis: Review of 180 cases. Medicine (Baltimore), 83, 139-148.
[9] Ryan, M.J., Kavanagh, R., Wall, P.G. and Hazleman, B.L. (1997) Bacterial joint infections in England and Wales: Analysis of bacterial isolates over a four year period. British Journal of Rheumatology, 36, 370-373. doi:10.1093/rheumatology/36.3.370
[10] Patti, J.M., Allen, B.L., McGavin, M.J., et al. (1994) MSCRAMM-mediated adherence of microorganisms to host tissues. Annual Review of Microbiology, 48, 585-617. doi:10.1146/annurev.mi.48.100194.003101
[11] Margaretten, M.E., Kohlwes, J., Moore, D. and Bent, S. (2007) Does this adult patient have septic arthritis? JAMA, 297, 1478-1488. doi:10.1001/jama.297.13.1478
[12] Mathews, C.J., Weston, V.C., Jones, A., et al. (2010) Bacterial septic arthritis in adults. Lancet, 375, 846-855. doi:10.1016/S0140-6736(09)61595-6
[13] Schumacher Jr., H.R. (2001) Synovial fluid analysis and synovial biopsy. In Ruddy, S., Harris, E.D., Sledge, C.B. and Kelley, W.N., Eds., Kelley’s Textbook of Rheumatology, 6th Edition, Saunders, Philadelphia.
[14] Shmerling, R.H., Delbanco, T.L., Tosteson, A.N. and Trentham, D.E. (1990) Synovial fluid tests. What should be ordered? JAMA, 264, 1009-1014. doi:10.1001/jama.1990.03450080095039
[15] Mathews, C.J., Weston, V.C., Jones, A., Field, M. and Coakley, G. (2010) Bacterial septic arthritis in adults. Lancet, 375, 846-855. doi:10.1016/S0140-6736(09)61595-6
[16] Weston, V.C., Jones, A.C., Bradbury, N., et al. (1999) Clinical features and outcome of septic arthritis in a single UK health district 1982-1991. Annals of the Rheumatic Diseases, 58, 214-219. doi:10.1136/ard.58.4.214
[17] Coakley, G., Mathews, C., Field, M., et al. (On Behalf of the British Society for Rheumatology Standards) (2006) Guidelines and Audit Working Group: BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford), 45, 1039-1041. doi:10.1093/rheumatology/kel163a
[18] Li, S.F., Henderson, J., Dickman, E., et al. (2004) Laboratory tests in adults with monoarticular arthritis: Can they rule out a septic joint? Academic Emergency Medicine, 11, 276-280. doi:10.1111/j.1553-2712.2004.tb02209.x
[19] Gupta, M.N., Sturrock, R.D. and Field, M. (2001) A prospective 2-year study of 75 patients with adultonset septic arthritis. Rheumatology (Oxford), 40, 24-30. doi:10.1093/rheumatology/40.1.24
[20] Sanchez, R.B. and Quinn, S.F. (1989) MRI of inflammatory synovial processes. Magnetic Resonance Imaging, 7, 529-540. doi:10.1016/0730-725X(89)90406-2
[21] Goldenberg, D.L. (1994) Bacterial arthritis. Current Opinion in Rheumatology, 6, 394-400. doi:10.1097/00002281-199407000-00008
[22] Kaandorp, C.J.E., Dinant, H.J., van de Laar, M.A.F.J., et al. (1997) Incidence and sources of native and prosthetic joint infection: A community based prospective survey. Annals of the Rheumatic Diseases, 56, 470-475. doi:10.1136/ard.56.8.470
[23] Ross, J.J., Saltzman, C.L., Carling, P., et al (2003) Pneumococcal septic arthritis: Review of 190 Cases. Clinical Infectious Diseases, 36, 319-327. doi:10.1086/345954

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.