Tietze's Syndrome Post-COVID-19 Infection in an Adult Patient

Abstract

Tietze's syndrome is a rare inflammatory disorder characterized by chest well swelling and inflammation of the costal cartilages. We describe a gentleman with repeated presentations to the emergency department (ED) with left-sided chest and sternoclavicular pain on a background of recent asymptomatic coronavirus disease 2019 (COVID-19) infection. He had elevated inflammatory markers and MRI subsequently confirmed the diagnosis of Tietze's syndrome. Anti-inflammatory medications and colchicine eventually led to a complete resolution of symptoms. This case highlights how Tietze's syndrome -- a disorder that is potentially self-limiting, can cause great distress and should be a differential diagnosis of chest pain after excluding life-threatening etiologies related to COVID-19.

Keywords: chest pain; costochondritis; covid-19; post-covid-19; tietze syndrome; tietze’s syndrome.

Figure 1. Axial fat suppressed fluid-sensitive MRI shows edema in the left distal first rib and surrounding soft tissue, in keeping with costochondritis. There is also mild signal change in the adjacent medical clavicle head. There is neither significant effusion of the left sternoclavicular joint, nor is there marrow edema in the sternum. The overlying pectoralis major muscle is edematous, likely secondary to reactive change.

Figure 2. Coronal fat suppressed fluid sensitive MRI shows edema in the left distal first rib and surrounding soft tissue, in keeping with costochondritis. There is also mild signal change in the adjacent medical clavicle head. There is neither significant effusion of the left sternoclavicular joint, nor is there marrow edema in the sternum. The overlying pectoralis major muscle is edematous, likely secondary to reactive change.