Primary Sternal Osteomyelitis caused by Staphylococcus aureus in an Immunocompetent Adult

Abstract

Primary sternal osteomyelitis (PSO) is a rare condition that may develop without any contiguous focus of infection. Due to the rarity of the disease, early diagnosis and appropriate treatment are often delayed. Herein, we describe a patient with PSO caused by Staphylococcus aureus that presented with chest pain and fever. The patient had no predisposing factors for sternal osteomyelitis. The chest pain was thought to be non-cardiogenic, as electrocardiography and cardiac enzyme did not reveal ischemic changes when he visited the emergency room. After blood culture revealed the presence of S. aureus, every effort was made to identify the primary focus of infection. Bone scan and magnetic resonance imaging revealed osteomyelitis with soft tissue inflammation around the sternum. After 8 weeks of antibiotics treatment, the patient recovered without any complications.

Keywords: Immunocompetent host; Osteomyelitis; Staphylococcus aureus; Sternum.

Figure 1

Whole body bone scan with Tc99m DPD on the 3rd hospital day, showed increased uptake in and around sternomanubrial junction.

Figure 2

(A) Sternum series showed subtle sclerosis along the manubriosternal junction. (B) Contrast enhanced sagittal T1-weighted MRI of chest on the 7th hospital day showed an ill-defined high signal intensity of bone marrow at the sternomanubrial joint with enhancement. Surrounding soft tissue inflammatory change was also seen at pre- and retrosternal region with enhancement.