Septic Arthritis And Osteomyelitis Of The Acromioclavicular Joint Diagnosed By Bone Scan
Q Chai,, C Bui, R Mansberg, D Nguyen
Keywords
acromioclavicular joint septic arthritis, bone scan
Citation
Q Chai,, C Bui, R Mansberg, D Nguyen. Septic Arthritis And Osteomyelitis Of The Acromioclavicular Joint Diagnosed By Bone Scan. The Internet Journal of Nuclear Medicine. 2006 Volume 4 Number 1.
Abstract
A 42 year old febrile non intravenous drug user male presented with a painful right shoulder and a history of trauma 4 weeks earlier without evidence of overlying skin penetration. Inflammatory markers were elevated and a blood culture was positive for Staphylococcus aureus. Initial interpretations of plain radiographs and computed tomography (CT) of the right shoulder were non-diagnostic. A bone scan confirmed septic arthritis and osteomyelitis of the acromioclavicular joint (ACJ) and allowed prompt recognition and effective therapy to prevent joint destruction without the need for tissue culture.
Case Report
A 42 year old febrile non intravenous drug user male presented with a painful right shoulder and a history of trauma 4 weeks earlier without evidence of overlying skin penetration. Inflammatory markers were elevated and a blood culture was positive for Staphylococcus aureus. Initial interpretations of plain radiographs and computed tomography (CT) of the right shoulder were non-diagnostic. A bone scan confirmed septic arthritis and osteomyelitis of the acromioclavicular joint (ACJ) and allowed prompt recognition and effective therapy to prevent joint destruction without the need for tissue culture.
Figure 1
Figure 3
The final diagnosis was septic arthritis with osteomyelitis of the right AC joint, with associated inflammation/ infection of the surrounding soft tissues. The patient improved with intravenous antibiotic therapy.
Discussion
Septic arthritis of the acromioclavicular joint (ACJ) is rare1, 2, 3, 4, and has been reported in association with intravenous drug abuse, renal dialysis and acquired immunodeficiency syndrome1, 2, 4. Septic arthritis tends to affect unusual joints in these individuals/ conditions. The most common infecting organisms are Staphylococcus aureus and Haemophilus influenzae2, 5,6,7,8,9. In this case, no obvious source of infection and no associated risk factors were identified, but functional imaging with bone scintigraphy complemented other imaging modalities in localizing the site of pathology and aided in the diagnosis.
Correspondence to
Dr Robert Mansberg Department of Nuclear Medicine Nepean Hospital Penrith 2751 New South Wales Australia Telephone: 61 2 4734 2156 Facsimile: 61 2 4734 1348 Email: mansberg@mail.usyd.edu.au