title: Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature.
abstract: BACKGROUND Sternoclavicular osteomyelitis is a rare disease, with less than 250 cases identified in the past 50 years. We present a rare case of sternoclavicular osteomyelitis in an immunosuppressed patient that developed from a conservatively treated dislocation. CASE REPORT A 62-year-old white man with a history of metastatic renal cell carcinoma presented to the emergency department (ED) with a dislocated left sternoclavicular joint. He was managed conservatively and subsequently discharged. However, over subsequent days he began to experience pain, fever, chills, and night sweats. He presented to the ED again and imaging revealed osteomyelitis. In the operating room, the wound was aggressively debrided and a wound vac (vacuum-assisted closure) was placed. He was diagnosed with sternoclavicular osteomyelitis and placed on a 6-week course of intravenous Nafcillin. CONCLUSIONS Chemotherapy patients who sustain joint trauma normally associated with a low risk of infection should be monitored thoroughly, and the option to discontinue immunosuppressive therapy should be considered if signs of infection develop.
authors.affiliation: Division of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
authors.affiliation: Division of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wozniak
authors.affiliation: Division of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
authors.forename: Erfan
authors.initials: E
authors.lastname: Mehrabi
authors.affiliation: Aureus University School of Medicine, Oranjestad, Aruba.
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Giannone
authors.affiliation: Division of Internal Medicine, Maryland General Hospital, Baltimore, MD, USA.
authors.forename: Mitul
authors.initials: M
authors.lastname: Dave
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D006801:Humans; D016867:Immunocompromised Host; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009254:Nafcillin / Q000008:administration & dosage; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013247:Sternoclavicular Joint; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D009254:Nafcillin