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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray &#40;left&#41; and CT &#40;right&#41; showing an infiltrate at the right lung base and pleural effusion on the same side&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Attention of a patient with a swollen joint and fever is a medical emergency due to the possibility of septic arthritis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The sternoclavicular joint is a rare localization for septic arthritis in patients without risk factors &#40;intravenous drug users &#91;IDU&#93;&#41;&#44; immunocompromised patients&#44; diabetes&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this type of involvement there are serious possible complications such as abscesses&#44; mediastinitis&#44; osteomyelitis and empyema&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Here&#44; we report the case of a patient with sternoclavicular septic arthritis and secondary empyema&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient&#44; a 63-year-old male was admitted to our hospital for right shoulder pain lasting one week and three days with high fever&#46; He had a painful tumor on the right sternoclavicular region and discrete pulmonary hypoventilation at the base of the same side&#46; The rest of the examination was unremarkable and revealed no history of risk factors&#46; He had leukocytosis with neutrophilia&#44; elevated erythrocyte sedimentation rate &#40;ESR&#41; and fibrinogen&#44; no other laboratory abnormalities&#46; Chest X-ray showed a condensing image in the right upper lobe and a diffuse condensation of the right base &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Shoulder X-rays showed no abnormalities&#46; The chest CT observed disintegration of the articular margins and periarticular fluid collection which continued to the subclavicular region&#44; anterior pleural and right lung base &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We performed arthrocentesis of the acromioclavicular joint&#44; isolating <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;<span class="elsevierStyleItalic">S&#46; aureus</span>&#41; in the synovial fluid and in blood cultures&#46; According to the antibiogram&#44; the patient was treated with intravenous cloxacyllin&#46; We performed a thoracocenthesis and obtained a liquid with data of infection and an analytical result with a high suspicion of empyema&#44; so we placed a chest drainage tube&#46; With both treatments there was a significant improvement and resolution of the problem&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The incidence of septic arthritis appears to increase in certain types of population &#40;prosthetic infections&#44; immunocompromised&#44; IDU&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The sternoclavicular joint may be affected by 9&#37; of cases of septic arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical presentation is usually insidious&#44; with pain localized to the shoulder or paracervical region&#44; which may delay diagnosis&#44; increasing the percentage of local complications&#44; abscesses and even the extension of the process within the thorax&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">One study 1 describes the target population for this type of septic arthritis as a young population&#46; In our case&#44; the patient exceeded the average age suggested by these authors &#40;45 years&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In all age groups at risk the most common organisms identified was <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; as in our case&#44; as well as in other gram positive agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the case of sternoclavicular septic arthritis&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> causes half of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; we must not forget other organisms such as <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; which is a major cause of septic arthritis in certain patient groups such as IVDU&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Given the potential for serious complications described above&#44; a chest CT should be performed after a chest X-ray and at any abnormality of the latter&#46; Our patient had no clear respiratory symptoms&#44; except for a mild dry cough three days before admission&#44; as well as fever and malaise during the same days&#44; so one must be guided not only by the clinical data&#46; From the onset we started antimicrobial therapy against <span class="elsevierStyleItalic">S&#46; aureus</span> with oxacyllin or vancomycin&#44; due to the risk of resistance to methicillin&#46; If the patient belonged to a different risk group we would have covered gram-negatives with cephepime or piperacyllin-tazobactam&#44; for example&#44; or in case of carbapenem resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We report a patient with sternoclavicular septic arthritis and secondary empyema&#44; with no risk factors and who started as a painful shoulder&#46; These facts have encouraged us to communicate the clinical features&#44; diagnosis and treatment&#44; having thought about the possibility of sternoclavicular arthritis when we observed fever accompanied by severe pain in the shoulder or paracervical region&#46;</p></span>"
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Letter to the Editor
Sternoclavicular Septic Arthritis and Empyema
Artritis séptica esternoclavicular y empiema
María José Moreno Martínez
Corresponding author
mjmorenomartinez@gmail.com

Corresponding author.
, Manuel José Moreno Ramos, Luis F. Linares Ferrando, Carlos Marras Fernandez-Cid, Manuel Castaño Sanchez, Elena Peñas Martínez
Servicio de Reumatología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Attention of a patient with a swollen joint and fever is a medical emergency due to the possibility of septic arthritis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The sternoclavicular joint is a rare localization for septic arthritis in patients without risk factors &#40;intravenous drug users &#91;IDU&#93;&#41;&#44; immunocompromised patients&#44; diabetes&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this type of involvement there are serious possible complications such as abscesses&#44; mediastinitis&#44; osteomyelitis and empyema&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Here&#44; we report the case of a patient with sternoclavicular septic arthritis and secondary empyema&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient&#44; a 63-year-old male was admitted to our hospital for right shoulder pain lasting one week and three days with high fever&#46; He had a painful tumor on the right sternoclavicular region and discrete pulmonary hypoventilation at the base of the same side&#46; The rest of the examination was unremarkable and revealed no history of risk factors&#46; He had leukocytosis with neutrophilia&#44; elevated erythrocyte sedimentation rate &#40;ESR&#41; and fibrinogen&#44; no other laboratory abnormalities&#46; Chest X-ray showed a condensing image in the right upper lobe and a diffuse condensation of the right base &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Shoulder X-rays showed no abnormalities&#46; The chest CT observed disintegration of the articular margins and periarticular fluid collection which continued to the subclavicular region&#44; anterior pleural and right lung base &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We performed arthrocentesis of the acromioclavicular joint&#44; isolating <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;<span class="elsevierStyleItalic">S&#46; aureus</span>&#41; in the synovial fluid and in blood cultures&#46; According to the antibiogram&#44; the patient was treated with intravenous cloxacyllin&#46; We performed a thoracocenthesis and obtained a liquid with data of infection and an analytical result with a high suspicion of empyema&#44; so we placed a chest drainage tube&#46; With both treatments there was a significant improvement and resolution of the problem&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The incidence of septic arthritis appears to increase in certain types of population &#40;prosthetic infections&#44; immunocompromised&#44; IDU&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The sternoclavicular joint may be affected by 9&#37; of cases of septic arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical presentation is usually insidious&#44; with pain localized to the shoulder or paracervical region&#44; which may delay diagnosis&#44; increasing the percentage of local complications&#44; abscesses and even the extension of the process within the thorax&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">One study 1 describes the target population for this type of septic arthritis as a young population&#46; In our case&#44; the patient exceeded the average age suggested by these authors &#40;45 years&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In all age groups at risk the most common organisms identified was <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; as in our case&#44; as well as in other gram positive agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the case of sternoclavicular septic arthritis&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> causes half of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; we must not forget other organisms such as <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; which is a major cause of septic arthritis in certain patient groups such as IVDU&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Given the potential for serious complications described above&#44; a chest CT should be performed after a chest X-ray and at any abnormality of the latter&#46; Our patient had no clear respiratory symptoms&#44; except for a mild dry cough three days before admission&#44; as well as fever and malaise during the same days&#44; so one must be guided not only by the clinical data&#46; From the onset we started antimicrobial therapy against <span class="elsevierStyleItalic">S&#46; aureus</span> with oxacyllin or vancomycin&#44; due to the risk of resistance to methicillin&#46; If the patient belonged to a different risk group we would have covered gram-negatives with cephepime or piperacyllin-tazobactam&#44; for example&#44; or in case of carbapenem resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We report a patient with sternoclavicular septic arthritis and secondary empyema&#44; with no risk factors and who started as a painful shoulder&#46; These facts have encouraged us to communicate the clinical features&#44; diagnosis and treatment&#44; having thought about the possibility of sternoclavicular arthritis when we observed fever accompanied by severe pain in the shoulder or paracervical region&#46;</p></span>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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