Septic Arthritis of the Sternoclavicular Joint in an Intravenous Drug User

1Good Samaritan Hospital, Cincinnati, OH
2Good Samaritan Hospital, Cincinnati, OH
3Good Samaritan Hospital, Cincinnati, OH
4Good Samaritan Hospital, Cincinnati, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 506

Case Presentation:

Septic arthritis of the sternoclavicular joint (SCJ) comprises fewer than 1% of all cases of septic arthritis. Risk factors are diabetes mellitus, subclavian venous catheterization, intravenous drug use (IVDU), cirrhosis, and rheumatoid arthritis. Methicillin‐resistant Staphylococcus aureus (MRSA) is the most common etiology. We are presenting a case of septic arthritis of the SCJ with an uncommon bacteria in a young IVDU that ended up to complications. A 34‐year‐old white man with a history of IV heroin abuse and hepatitis C, presented to the emergency room (ER) with severe right shoulder pain and chest swelling. It started 3 weeks prior as a sharp shoulder pain with no fever or chills that he related it to his job, landscaping. Three days later he went to the ER. He was diagnosed with muscle strain and sent home with ibuprofen. He went back to ER again after 1 week due to worsening of the pain and low‐grade fever. The pain was more felt in the SCJ. His labs were normal. Chest x‐ray showed some soft‐tissue swelling. He was diagnosed with Bursitis and sent home with steroids. After one week he developed high‐grade fever, excruciating shoulder pain and chest swelling. He came to ER again. He had no chills, neck pain, palpitation shortness of breath. He quit working during the last week due to the pain. He denied any tobacco or alcohol abuse. He mentioned intravenous heroin injection to the right arm two weeks ago. In the physical, he appeared sick with tachycardia, tachypnea, temperature of 102.0°F and O2 saturation of 99% on room air. He had a right chest wall erythema, tenderness and firm swelling that were extending from the SCJ to the axillary area. The range of motion was significantly decreased in the right shoulder. In the labs he had leukocytosis (83% neutrophils). The chest CT showed the septic arthritis of the SCJ with osteomyelitis of the first rib and abscess. Blood cultures were sent, and the patient was started on empirical antibiotics. Surgery was consulted. The blood culture grew Serratia marcescens. Treatment was continued with ertapenem and he underwent an excisional debridement of the SCJ with biopsy. The bone cultures also grew Serratia. After 5 days he was discharged to a nursing home to continue treatment for 6 weeks.

Discussion:

Septic arthritis of the SCJ in IVDUs is due to direct injection of the contaminated drug to the subclavian vein or any other upper‐extremity vein. Serratia marcescens is a rare cause, which is usually found in contaminated water.

Conclusions:

Because the serious morbidity and mortality of this infection, SCJ septic arthritis should be considered in any IVDU who presents with shoulder and chest discomfort. Early diagnosis and treatment is very important to prevent serious complications like osteomyelitis and mediastinitis.

To cite this abstract:

Pourpaki M, Raeissi S, Blatt S, Friedstrom S. Septic Arthritis of the Sternoclavicular Joint in an Intravenous Drug User. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 506. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/septic-arthritis-of-the-sternoclavicular-joint-in-an-intravenous-drug-user/. Accessed September 22, 2019.

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