Septische artritis van het sternoclaviculair gewricht: een ongewone infectie

Septic arthritis of the sternoclavicular joint: an uncommon infection Septic arthritis of the sternoclavicular joint is rare and often occurs in patients with predisposing factors such as intravenous drug use, diabetes mellitus, trauma, or infection elsewhere in the body. It presents mostly insidiously and can lead to serious complications such as osteomyelitis and mediastinitis, primarily caused by Staphylococcus aureus. Treatment involves antibiotics, drainage, and in severe cases, joint resection. We present the case of a 74-year-old man with neck and thoracic pain lasting for one week. Examination revealed tenderness in the sternocleidomastoid muscle without redness or swelling, and tenderness at the sternoclavicular joint. Blood tests showed elevated inflammatory markers. CT-scan revealed soft tissue infiltration around the sternocleidomastoid muscle without abscess formation. Differential diagnoses included infectious, inflammatory, neoplastic, and mechanical causes. A PET-CT-scan was suggestive of septic arthritis with intramuscular abscess of the sternocleidomastoid muscle. Culture of a sample obtained by transcutaneous puncture was positive for Streptococcus mitis group. Ultrasound confirmed abscess formation and synovitis. Broad-spectrum antibiotics were initiated, and percutaneous evacuating puncture was done. Subsequent ultrasounds showed a decrease in abscess volume, but only with a slow decline in inflammatory markers. This case of septic arthritis of the sternoclavicular joint highlights the challenges of diagnosing and treating this rare condition. It is crucial to recognize that most cases arise from hematogenous spread of infections, necessitating a thorough evaluation for possible infectious foci elsewhere in the body. Early identification of the causative bacteria is essential for targeted treatment and prevention of severe complications. Multidisciplinary collaboration is necessary for an effective approach.