title: Tuberculosis of the sternoclavicular joint.
abstract: OBJECTIVE
  To review the diagnosis and treatment of tuberculosis of the sternoclavicular joint in 13 patients.
  
  
  METHODS
  Records of 9 men and 4 women aged 26 to 47 (mean, 36.5) years who presented with tuberculosis of the right (n=8) or left (n=5) sternoclavicular joint were reviewed.
  
  
  RESULTS
  All 13 patients had a raised erythrocyte sedimentation rate at presentation. Nine patients presented with systemic symptoms including malaise, fever, or loss of weight/appetite. Local symptoms included cold abscess (n=5), tenderness and non-fluctuant swelling (n=4), and discharging sinus (n=4). The mean duration of symptoms was 2.7 (range, 1-7) months. Four patients had multifocal involvement of the proximal ulna (n=1), lung (n=2), and meninges (n=1). Aspiration (n=3), fine needle aspiration cytology (n=4), drainage (n=2), or curettage (n=4) of the swelling, abscess, or sinus was performed, and the diagnosis was confirmed by histopathology (n=8), polymerase chain reaction (n=5), or culture (n=1). Two patients were diagnosed based on clinical suspicion. 11 patients responded to antituberculous therapy (ATT), and symptoms resolved after 6 to 8 weeks. Two patients did not respond to ATT after 3 months and were screened for immunocompromising disorders or drug resistance. Their CD4 count and CD4:CD8 ratio was low, and an immunomodulation regimen was prescribed as an adjunct to ATT.
  
  
  CONCLUSIONS
  A high level of clinical suspicion is needed to diagnose tuberculosis of the sternoclavicular joint in patients with pain/tenderness, discharging sinus, or cold abscess. A combination of histopathological and microbiological tests, and PCR can confirm the diagnosis.
authors.affiliation: University College of Medical Sciences and associated Guru Teg Bahadur Hospital, Delhi, India.
authors.forename: Anuj
authors.initials: A
authors.lastname: Jain
authors.forename: Nitesh
authors.initials: N
authors.lastname: Jajodia
authors.forename: Aditya
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Singh
authors.forename: Siddharth
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000038:Abscess / Q000209:etiology / Q000628:therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001799:Blood Sedimentation; D004322:Drainage; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013247:Sternoclavicular Joint; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents
keywords: sternoclavicular joint; tuberculosis, osteoarticular