Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease
Kamran Khan, Susan E. Wozniak, Erfan Mehrabi, Anna Lucia Giannone, Mitul Dave
(Division of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA)
Am J Case Rep 2015; 16:908-911
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.
Keywords: Anti-Bacterial Agents - administration & dosage, Humans, Immunocompromised Host, Injections, Intravenous, Male, Middle Aged, Nafcillin - administration & dosage, Osteomyelitis - microbiology, Staphylococcal Infections - microbiology, Staphylococcus aureus - isolation & purification, Sternoclavicular Joint, Tomography, Spiral Computed - methods