Artritis infecciosa esternoclavicular: serie de 5 casos y revisión de la literatura

doi:10.1016/j.reuma.2014.03.002

Reumatología Clínica

Volume 11, Issue 1, January–February 2015, Pages 48-51

https://doi.org/10.1016/j.reuma.2014.03.002 Get rights and content

Resumen

La artritis infecciosa es una urgencia médica de cuyo rápido diagnóstico depende el pronóstico a corto y medio plazo del estado general del paciente y de la funcionalidad final de la articulación. La articulación esternoclavicular es una región de baja prevalencia de este tipo de artritis, aunque su frecuencia se suele concentrar en pacientes inmunosuprimidos, usuarios de drogas parenterales o tras procedimientos traumáticos. Presentamos una serie de 5 casos microbiológicamente documentados de artritis infecciosa esternoclavicular, 3 de los cuales se presentaron en pacientes inmunocompetentes, y una revisión de esta peculiar enfermedad.

Abstract

Infectious arthritis is a medical emergency whose prognosis, in terms of general morbidity and the final functionality of the joint, depends on rapid diagnosis and treatment. The sternoclavicular joint is an area of low prevalence of this type of arthritis, although its frequency is often concentrated in immunosuppressed patients, users of parenteral drugs or after traumatic events. We present a series of 5 microbiologically documented cases of sternoclavicular septic arthritis, 3 of which occurred in immunocompetent patients, and a short review of this pathology.

Section snippets

Introducción

Las artritis sépticas de articulaciones nativas (ASAN) representan un problema diagnóstico dado que su clínica cardinal y semiología es superponible a la de otras formas de artritis1, 2. Además, ciertas localizaciones topográficas hacen más difícil su reconocimiento por tratarse de sinoviales escasamente distensibles, con poca permeabilidad inflamatoria o ciertamente infrecuentes. Este es el caso de la articulación esternoclavicular, una articulación en la que enfermedad infecciosa es

Observación clínica

Presentamos una serie de 5 casos de ASAN esternoclavicular diagnosticados en el Servicio de Urgencias de nuestro hospital entre 2012 y 2013, ninguno de los cuales ha sido incluido previamente en otras series (tabla 1).

Caso 1. Varón de 45 años. Consultó por dolor clavicular de 2 semanas de evolución y fiebre de inicio reciente con dolor y tumefacción esternoclavicular. La ecografía demostró distensión capsular con señal power doppler (SPD) intraarticular y periarticular. El paciente fue tratado

Discusión y conclusiones

La ASAN esternoclavicular es una enfermedad infrecuente, tanto en pacientes inmunocompetentes como en inmunosuprimidos1, 7. La recopilación más grande de la literatura científica mundial incluye 170 casos provenientes de más de 70 series publicadas entre 1970 y 2004⁶. Otra recopilación más reciente publicada en 2004 recoge 15 casos, suficientemente documentados entre 1989 y 2012⁵. Se ha descrito habitualmente entre la cuarta y quinta década de la vida, al igual que otras ASAN de localización

Protección de personas y animales

Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.

Confidencialidad de los datos

Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicación de datos de pacientes y que todos los pacientes incluidos en el estudio han recibido información suficiente y han dado su consentimiento informado por escrito para participar en dicho estudio.

Derecho a la privacidad y consentimiento informado

Los autores han obtenido el consentimiento informado de los pacientes y/o sujetos referidos en

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

Bibliografía (9)

M. Martínez-Morillo et al.
Septic arthritis of the acromioclavicular joint: An uncommon location
Reumatol Clin
(2014)
J. Womack
Septic arthritis of the sternoclavicular joint
J Am Board Fam Med
(2012)
R.A. Yood et al.
Sternoclavicular joint arthritis
Arthritis Rheum
(1980)
J.J. Ross et al.
Sternoclavicular septic arthritis: Review of 180 cases
Medicine (Baltimore)
(2004)

There are more references available in the full text version of this article.

Cited by (13)

Relevance of a normal ultrasound study in patients with non-traumatic acute shoulder pain
2020, Reumatologia Clinica
Dorsal costo-vertebral joint as a rare localization of Staphylococcus aureus sepsis
2018, Egyptian Rheumatologist
Citation Excerpt :
Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or arthroscopic drainage in the operating room, or imaging-guided drainage in the radiology suite, is mandatory [1]. The prognosis of infectious arthritis, in terms of general morbidity and the final functionality of the joint, depends on rapid diagnosis and treatment [2]. There are new approaches to diagnosis of septic arthritis but therapy remains a challenge, with a need for careful consideration of a combined medical and surgical approach in most cases [3].
Septic arthritis of the costovertebral thoracic joint is a rare site infection. We report an isolated case of septic arthritis of the 10th costo-vertebral right joint with osteitis due to Staphylococcus aureus.
A 59 year old Tunisian man presented with a 2 months history of dorsal spinal pain with fever, associated with asthenia, anorexia and loss of weight. There was a raised C-reactive protein (176 mg/L) and erythrocyte sedimentation rate (100 mm/1st h). Tests for tuberculosis and brucellosis were negative. In the present patient, the clinical symptoms were unspecific with lack of obvious predisposing factors. He had neither history of taking immunosuppressors nor of any disease indicative of immunodeficiency. Thoraco-abdominal computed tomography (CT) showed a lytic lesion centered on the 10th costo-vertebral right joint and histo-pathologic exam of the costo-vertebral puncture confirmed chronic active osteitis and bacteriologic culture allowed identifying methicillin-sensitive Staphylococcus aureus. The patient was treated with ciprofloxacin 1500 mg/day, associated with daily rifampin (20 mg/kg) for total treatment duration of 12 weeks after consulting infectious disease specialists. After a follow-up of 6 months, the patient remained asymptomatic and the markers of inflammation negative.
Septic arthritis of costovertebral joints should be considered when a patient presents with back pain, fever and elevated inflammatory markers. The diagnosis of septic arthritis of costovertebral joints remain a challenge to clinicians. CT is important to confirm a diagnosis and guide costovertebral biopsy and culture. Early and appropriate antibiotic therapy is important for a required outcome.
Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens
2018, IDCases
Citation Excerpt :
The diagnosis of sternoclavicular septic arthritis can be delayed, due to insidiousness of symptoms, by days to weeks. Fever is noted in 65% of cases, and patients are likely to complain of chest or shoulder pain [1,2,5]. Imaging evaluation may start with chest radiography, although CT and MRI are vital for early diagnosis.
An 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of antimicrobials. No fevers were documented. During the admission an ¹⁸F-FDG PET/CT was performed in continuation of his sarcoma staging workup. This revealed unexpected abnormal radiotracer uptake in the left sternoclavicular joint with fluid collections extending into the sternocleidomastoid muscle and the mediastinum. Imaging findings were consistent with septic arthritis and abscess formation, despite lack of fever or localizing symptoms. Ultrasound-guided aspiration revealed purulent fluid that grew Moraxella nonliquefaciens. Given the unusual presentation, ongoing clinical uncertainty about the true cause of the septic joint, and concern for an occult sarcoma metastasis, surgical debridement and resection of the joint was carried out. Pathology and microbiology evaluation confirmed septic arthritis with osteomyelitis and abscess extension into the mediastinum. No tumor cells were identified. Postoperative course was complicated by hematoma, but otherwise the patient responded well to antimicrobial therapy.
Serratia marcescens septic sternoclavicular joint arthritis: A case report
2016, Reumatologia Clinica
Osteoarticular infections caused by Streptococcus pneumoniae since authorization of conjugate vaccines
2019, Reumatologia Clinica
Arthrocentesis of suspected septic sternoclavicular arthritis: microbial yield and predictors of culture positivity
2024, Skeletal Radiology

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Caso clínicoArtritis infecciosa esternoclavicular: serie de 5 casos y revisión de la literaturaSternoclavicular septic arthritis: A series of 5 cases and review of the literature

Resumen

Abstract

Section snippets

Introducción

Observación clínica

Discusión y conclusiones

Protección de personas y animales

Confidencialidad de los datos

Derecho a la privacidad y consentimiento informado

Conflicto de intereses

Reumatol Clin

Septic arthritis of the sternoclavicular joint

J Am Board Fam Med

Sternoclavicular joint arthritis

Arthritis Rheum

Sternoclavicular septic arthritis: Review of 180 cases

Medicine (Baltimore)

Caso clínico
Artritis infecciosa esternoclavicular: serie de 5 casos y revisión de la literaturaSternoclavicular septic arthritis: A series of 5 cases and review of the literature