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


METHODS
A 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.


CONCLUSIONS
Diabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.
Department of Critical Care and Emergency, Iwate Medical University, Morioka, Japan. fukubuku@xg7.so-net.ne.jp
Nobuki
N
Shioya
Yoriko
Y
Ishibe
Shigenori
S
Kan
Takayuki
T
Masuda
Naoya
N
Matsumoto
Gaku
G
Takahashi
Hideyuki
H
Makabe
Yasuhiko
Y
Yamada
Shigeatsu
S
Endo
D000767:Anesthesia, Epidural / Q000009:adverse effects; D001170:Arthritis, Infectious / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D003287:Contrast Media; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D015299:Discitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D020802:Epidural Abscess / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007049:Iatrogenic Disease; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D013211:Staphylococcus aureus; D013247:Sternoclavicular Joint
D003287:Contrast Media