Spontaneous Bilateral Sternoclavicular Joint Septic Arthritis and Lumbar Discitis: An Unusual Case in a Healthy Adult

Abstract

Introduction: Septic arthritis of the sternoclavicular (SC) joint is a rare condition. Typically, it presents in patients with risk of infection and is usually unilateral. In this report, we describe a case of spontaneous bilateral sternoclavicular joint infection of an otherwise healthy adult.

Case presentation: A 67-year-old man presented in our hospital complaining of 2-week history of neck and chest pain which was radiating to his shoulders bilaterally. Clinical examination revealed erythema and swelling of the sternoclavicular area. Inflammatory markers were raised. Image investigation with CT and MRI was undertaken and verified the presence of bilateral sternoclavicular joint infection. The patient received prolonged course of intravenous antibiotics since his admission. The patient was discharged in a good condition and followed up in clinic.

Conclusion: High index of clinical suspicion of SC joint infection is important for early diagnosis to avoid further complications.

Figure 1

Erythema around bilateral sternoclavicular area in a “butterfly-like” distribution.

Figure 2

Chest CT scans. (a) Axial image; (b) coronal image showing evidence of bilateral sternocleidomastoid inflammation/infection. Thickened soft tissue was noted surrounding the SC joints and posterior to the sternum labelled by the red circle.

Figure 3

Sternoclavicular joints MRI scan STIR sequence. (a) Coronal image; (b) axial image showing moderate bone marrow edema in the medial third of the clavicles bilaterally, extending to the subarticular region. There was fluid signal in the SCJ space with mild to moderate marrow edema seen in the manubrium. No radiological signs of osteomyelitis were noted.

Figure 4

Lumbar spine MRI scan. (a) STIR sequence; (b) T2 sequence.