Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens

Ehab Saad Aldin; Poorani Sekar; Zein Saad Eddin; Jaclyn Keller; Janet Pollard

doi:10.1016/j.idcr.2018.03.011

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Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens

Journal article

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Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens

Ehab Saad Aldin, Poorani Sekar, Zein Saad Eddin, Jaclyn Keller and Janet Pollard

IDCases, Vol.12, pp.44-46

03/14/2018

DOI: 10.1016/j.idcr.2018.03.011

PMCID: PMC6010954

PMID: 29942746

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Published (Version of record)IDCases 12 (2018) 44–46

Abstract

Case Report An 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of anti-microbials. No fevers were documented. During the admission an 18 F-FDG PET/CT was performed in continuation of his sarcoma staging workup. This revealed unexpected abnormal radiotracer uptake in the left sternoclavicular joint with fluid collections extending into the sternocleidomastoid muscle and the mediastinum. Imaging findings were consistent with septic arthritis and abscess formation, despite lack of fever or localizing symptoms. Ultrasound-guided aspiration revealed purulent fluid that grew Moraxella nonliquefaciens. Given the unusual presentation, ongoing clinical uncertainty about the true cause of the septic joint, and concern for an occult sarcoma metastasis, surgical debridement and resection of the joint was carried out. Pathology and microbiology evaluation confirmed septic arthritis with osteomyelitis and abscess extension into the mediastinum. No tumor cells were identified. Postoperative course was complicated by hematoma, but otherwise the patient responded well to antimicrobial therapy.

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Moraxella nonliquefaciens

septic arthritis

Incidental diagnosis

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Title: Subtitle: Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens
Creators: Ehab Saad Aldin
Poorani Sekar - University of Iowa, Internal Medicine
Zein Saad Eddin
Jaclyn Keller
Janet Pollard - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: IDCases, Vol.12, pp.44-46
Publisher: Elsevier
DOI: 10.1016/j.idcr.2018.03.011
PMID: 29942746
PMCID: PMC6010954
ISSN: 2214-2509
eISSN: 2214-2509
Grant note: Funding Sources: None Competing Interests: The authors declare that they have no competing interests.
Language: English
Date published: 03/14/2018
Academic Unit: Radiology; Internal Medicine
Record Identifier: 9983763598102771

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