Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Septic Arthritis of the Manubriosternal Joint in an Adolescent: A Case Report

  • Soongang Park (Department of Pediatrics, Chungbuk National University Hospital) ;
  • Joon Kee Lee (Department of Pediatrics, Chungbuk National University Hospital)
  • Received : 2024.02.28
  • Accepted : 2024.04.01
  • Published : 2024.04.25
Download PDF
⟨ Previous Next ⟩

Abstract

Septic arthritis of the manubriosternal joint is a rare condition, especially in adolescents, who often present with nonspecific symptoms that can mimic more common conditions such as musculoskeletal chest pain, costochondritis. Here, we report a case of septic arthritis in a 17-year-old girl and highlight the challenges in diagnosing and managing this condition in adolescents. Initially presenting with acute chest pain diagnosed as transient nonspecific chest pain, the patient's subsequent visits to the emergency department unveiled escalating symptoms, including high fever, prompting advanced imaging. Ultimately, the diagnosis of septic arthritis of the manubriosternal joint was confirmed, with blood culture growth revealing Methicillin-sensitive Staphylococcus aureus. Diagnostic delays have been attributed to the absence of typical symptoms and patient reluctance to be hospitalized. Our case emphasizes the importance of considering rare infectious etiologies in adolescents with chest pain and emphasizes the need for heightened suspicion in unusual anatomical sites. Further research is required to elucidate the pathogenesis and risk factors associated with this condition to aid in prompt diagnosis and treatment.

Manubriosternal 관절의 패혈성 관절염은 특히 청소년에서 드물게 발생하는 질환으로, 종종 근골격 흉통, 갈비뼈염 등과 같은 보다 흔한 진단과 비슷하게 비특이적 증상으로 나타난다. 우리는 17세 소녀의 패혈성 관절염 사례를 보고하며 이러한 질환의 진단과 치료에 대한 어려움을 강조한다. 처음에는 일시적 비특이적 흉통으로 진단된 급성 흉통으로 시작하여, 환자의 응급실 재방문에서 고열과 같은 증상이 심화되어 추가적인 영상 촬영을 진행하였다. 결과적으로 Manubriosternal 관절의 패혈성 관절염 진단이 확인되었으며, 혈액 배양 결과 메티실린 감수성 황색포도상구균이 검출되었다. 진단 지연은 전형적인 증상의 부재 및 환자의 입원에 대한 소극적 태도 등이 영향을 끼친 것으로 보인다. 이 사례는 흉통이 있는 청소년에서 드문 감염 원인을 고려하는 중요성과 전형적이지 않은 해부학적 부위에서의 감염 의심의 필요성을 강조한다.

Keywords

Acknowledgement

This work was supported by the research grant of the Chungbuk National University in 2022.

References

  1. Peng EW, McKillop G, Prasad S, Walker WS. Septic arthritis of the manubriosternal joint. Ann Thorac Surg 2007;83:1190-4. https://doi.org/10.1016/j.athoracsur.2006.07.032
  2. Okubo Y, Nochioka K, Marcia T. Nationwide survey of pediatric septic arthritis in the United States. J Orthop 2017;14:342-6. https://doi.org/10.1016/j.jor.2017.06.004
  3. Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am 2015;29:557-74. https://doi.org/10.1016/j.idc.2015.05.012
  4. Sarcinelli JM, Eustaquio-Silva R, da Silva Baptista J. Manubriosternal joint: synchondrosis or symphysis? Analysis of morphology and aging in humans. Surg Radiol Anat 2019;41:275-9. https://doi.org/10.1007/s00276-018-2154-6
  5. Carnevale A, Righi R, Maniscalco P, Labaj O, Occhionorelli S, Benea G, et al. Primary septic arthritis of the manubriosternal joint in an immunocompetent young patient: a case report. Radiol Case Rep 2017;12:682-5. https://doi.org/10.1016/j.radcr.2017.08.006
  6. O'Connor A, Furtado S. Septic arthritis of the manubriosternal joint presenting as a chest-wall swelling in an immunocompetent patient. J Surg Case Rep 2019;2019:rjz261.
  7. Sorek A, Regev A, Ashkenazi-Hoffnung L, Tal R, Iluz M, Grisaru-Soen G. Rib Osteomyelitis in pediatric patients-case series and literature review. Pediatr Infect Dis J 2022;41:e506-9. https://doi.org/10.1097/INF.0000000000003712
  8. Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, et al. Clinical practice guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 guideline on diagnosis and management of acute bacterial arthritis in pediatrics. J Pediatric Infect Dis Soc 2024;13:1-59. https://doi.org/10.1093/jpids/piad089