Diagnosis and Management of Subacute Sternoclavicular Osteomyelitis and Septic Arthritis Secondary to Escherichia coli Infection

Abstract

Abstract Sternoclavicular Joint (SCJ) Osteomyelitis is a rare condition that can arise from a number of causes including trauma, infection via direct inoculation or hematogenous seeding. It is commonly caused by Staphylococcus aureus, and infrequently by other bacteria. Only cases of E. coli osteomyelitis have been reported in the literature. Patients with risk factors such as Diabetes, smoking history, and intravenous drug use are particularly susceptible. When infection seeds the joint space, septic arthritis can occur concurrently. Acute and subacute presentations of SCJ osteomyelitis and septic arthritis have been documented, with treatment modalities ranging from conservative treatment to surgical management. We describe a patient with an interesting case of SCJ Osteomyelitis with concurrent Septic Arthritis secondary to trauma to the area from a fall. We detail the patient’s presentation, hospital admission and course of treatment. We delve into her pre-existing conditions and comorbidities and outline the many challenges we faced in managing the patient from onset of presentation into recovery. We also perform a literature review of previously reported cases of SCJ Osteomyelitis. We determine that less than 350 cases have been identified and described in the literature, and we outline examples of some of these while comparing and contrasting pertinent aspects of some of these cases with our patient’s presentation and hospital course. SCJ Osteomyelitis and Septic Arthritis is a rare condition that warrants prompt identification and management to prevent destruction of bone and joint, bacteremia and sepsis, or other debilitating complications. A multidisciplinary approach must be therefore undertaken in caring for patients with existing comorbidities and/or risk factors. This includes expeditious testing and identification of causative organisms, administration of appropriate antibiotics and antipyretics as needed, and swift determination of patients' need for surgery to curtail the spread of infection and restore bone and joint health.