Septic sternoclavicular arthritis, osteomyelitis and mediastinitis

Abstract Background Septic arthritis in the sternoclavicular joint (SCJ) is uncommon. Early diagnosis is difficult because of its insidious onset and lack of a radiological reference standard. In addition to joint destruction and dysfunction, delayed diagnosis and treatment may result in additional expansion of infection, sepsis, and mortality. Case Report We present a previously healthy 38-year-old man who presented after 10 days of fever and painful swelling on the upper chest. Septic sternoclavicular arthritis and mediastinitis were diagnosed and treated by parenteral antibiotics and staged surgery. The range of motion in the right shoulder completely returned; however, mild weakness of the right shoulder remained. Conclusion In patients presenting with upper chest, neck, or shoulder pain, physicians should include SCJ arthritis as a differential diagnosis. Multiple imaging examinations are often needed to reach a diagnosis. In septic SCJ arthritis, early institution of appropriate antibiotics is important, and surgical interventions are often needed to eradicate the infection.