Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report

BMC Emergency Medicine

Case Report

Shigenori Kan¹  Hideyuki Makabe¹  Yasuhiko Yamada¹  Shigeatsu Endo¹  Yoriko Ishibe¹  Gaku Takahashi¹  Nobuki Shioya¹  Takayuki Masuda¹  Naoya Matsumoto¹ 

[1] Department of Critical Care and Emergency, Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan;

关键词: Sternoclavicular joint;    Septic arthritis;    Spondylitis;    Epidural abscess;    Epidural anesthesia;    Staphylococcus aureus;   

DOI  :  10.1186/1471-227X-12-7

 received in 2011-08-30, accepted in 2012-05-24,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundSeptic arthritis of the sternoclavicular joint (SCJ) is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes.Case presentationA 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2 weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain.ConclusionDiabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.

【 授权许可】

CC BY   
© Shioya et al.; licensee BioMed Central Ltd. 2012