Department of Critical Care and Emergency, Iwate Medical University, Morioka, Japan.
BMC Emerg Med. 2012 Jun 15;12:7. doi: 10.1186/1471-227X-12-7.
Septic arthritis of the sternoclavicular joint (SCJ) is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes.
A 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2 weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain.
Diabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.
胸骨锁骨关节（SCJ）的化脓性关节炎极为罕见，通常似乎是血行播散的结果。易患因素包括糖尿病等免疫功能低下的疾病。
一名 61 岁男性，患有未控制的糖尿病，因腰痛、高热和左侧 SCJ 疼痛性肿块到我院急诊科就诊。他在过去 2 周内因腰椎间盘突出症导致严重的腰背和腿部疼痛接受了 2 次硬膜外阻滞。他没有下肢无力或感觉改变，膀胱和肠道功能正常。他没有肩部注射、锁骨下静脉置管、静脉内药物滥用或包括龋齿在内的局部感染史。CT 显示左侧 SCJ 脓肿，延伸至纵隔和胸锁乳突肌，以及 L2 水平的左侧椎旁肌肉肿胀。MRI 显示 L3-L4 脊椎炎，伴有连续硬膜外脓肿。从 SCJ 抽吸脓液、尿液和血液中分离出金黄色葡萄球菌。切开并引流 SCJ 脓肿，并给予适当的静脉抗生素治疗。入院后 2 周，左侧 SCJ 的脓性分泌物完全停止，伤口好转。他被转至另一个病房治疗持续的背痛。
金黄色葡萄球菌菌血症的糖尿病患者可能通过血行播散而面临严重的肌肉骨骼感染的风险。
