Abstract
Background. A 54-year-old previously healthy white man presented to hospital with fever, right parasternal pain and swelling over the right second and third costochondral joints. The symptoms had developed 1 week earlier.
Investigations. Physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, blood and urine culture, plain radiography and CT of the chest, 99mTc bone scintigraphy, ultrasound-guided needle aspiration of soft tissue mass, Gram staining and culture of aspirated fluid.
Diagnosis. Meticillin-sensitive Staphylococcus aureus costochondritis.
Management. CT revealed a 2 × 5 cm soft tissue mass at the posterior aspect of the right second and third costochondral joints. The fluid aspirated contained Gram-positive cocci, and culture revealed the presence of meticillin-sensitive S. aureus. The patient received a 6-week course of flucloxacillin (2 g by intravenous injection every 6 h for 2 weeks, then 1 g orally every 6 h for 4 weeks). He responded well to treatment, and was discharged from hospital.
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References
Arias, C. A. & Murray, B. E. Antibiotic-resistant bugs in the 21st century—a clinical super-challenge. N. Engl. J. Med. 360, 439–443 (2009).
Miro, J. M. et al. Costochondral involvement in systemic candidiasis in heroin addicts: clinical, scintigraphic, and histologic features in 26 patients. Arthritis Rheum. 31, 793–797 (1988).
Ross, J. J. & Shamsuddin, H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore) 83, 139–148 (2004).
Weston, V. C., Jones, A. C., Bradbury, N., Fawthrop, F. & Doherty, M. Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann. Rheum. Dis. 58, 214–219 (1999).
Ross, J. J., Saltzman, C. L., Carling, P. & Shapiro, D. S. Pneumococcal septic arthritis: review of 190 cases. Clin. Infect. Dis. 36, 319–327 (2003).
Lowy, F. D. Staphylococcus aureus infections. N. Engl. J. Med. 339, 520–532 (1998).
Baum, C., Hsu, J. P. & Nelson, R. C. The impact of the addition of naloxone on the use and abuse of pentazocine. Public Health Rep. 102, 426–429 (1987).
Gur, E. et al. Clinical-radiological evaluation of poststernotomy wound infection. Plast. Reconstr. Surg. 101, 348–355 (1998).
Aeschlimann, A. & Kahn, M. F. Tietze's syndrome: a critical review. Clin. Exp. Rheumatol. 8, 407–412 (1990).
Colina, M., La Corte, R. & Trotta, F. Sustained remission of SAPHO syndrome with pamidronate: a follow-up of fourteen cases and a review of the literature. Clin. Exp. Rheumatol. 27, 112–115 (2009).
Gregory, P. L., Biswas, A. C. & Batt, M. E. Musculoskeletal problems of the chest wall in athletes. Sports Med. 32, 235–250 (2002).
Tabatabai, A. et al. Primary chest wall lymphoma with no history of tuberculous pyothorax: diagnosis and treatment. J. Thorac. Cardiovasc. Surg. 136, 1472–1475 (2008).
Moore, A. J., Parker, R. J. & Wiggins, J. Malignant mesothelioma. Orphanet. J. Rare Dis. 3, 34 (2008).
Shoji, T. et al. Giant primary liposarcoma of the chest. Gen. Thorac. Cardiovasc. Surg. 57, 159–161 (2009).
Coakley, G. et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford) 45, 1039–1041 (2006).
Mathews, C. J. & Coakley, G. Septic arthritis: current diagnostic and therapeutic algorithm. Curr. Opin. Rheumatol. 20, 457–462 (2008).
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Mohammad, A., Ambrose, N., Hamnvik, OP. et al. Meticillin-sensitive Staphylococcus aureus costochondritis in a healthy man. Nat Rev Rheumatol 5, 708–710 (2009). https://doi.org/10.1038/nrrheum.2009.216
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DOI: https://doi.org/10.1038/nrrheum.2009.216
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