The SCJ was incised and drained, and the abscess cavity was enlarged to include the abscess of the left sternocleidomastoid muscle. Sulbactam/ampicillin administration was started immediately. Aspirated pus, urine, and two sets of blood cultures all indicated S. aureus infection. FK228 order According to the results of antibiotic susceptibility testing, the patient’s antibiotic therapy was changed to cefotiam. After one week of antibiotic therapy, blood and wound cultures were negative for pathogens. Follow-up MRI clearly

showed abscess formation in the left paraspinal muscle at L1-L3, but culture of fluid aspirated from the abscess showed Inhibitors,research,lifescience,medical no growth. Figure 3 The left SCJ. Aspiration of the SCJ and culture of the obtained fluid Inhibitors,research,lifescience,medical yielded a growth of S. aureus. The patient’s general condition improved significantly and his fever subsided after 4days. The wound at the SCJ was irrigated daily. Twelve days after the onset of treatment, his plasma

WBC was 7,050/mm3 with 78% neutrophils. Two weeks after admission, there was a still a non-tender swelling over the left SCJ, but the purulent Inhibitors,research,lifescience,medical secretion had completely resolved. Neurological examination of the lower limbs was unchanged. Eight weeks after admission, he was transferred to the spinal surgery unit to undergo evaluation for operative treatment of his spondylitis and epidural abscess. Discussion It is likely that this patient’s epidural block caused the paraspinal muscle abscess Inhibitors,research,lifescience,medical and nearby lumbar spondylodiscitis,

and that this iatrogenic infection spread hematogenously to the SCJ. Septic arthritis most commonly affects the weight-bearing joints of the lower limb, which account for 61-79% of all reported cases of septic arthritis [8]. The knee is the most commonly affected joint, followed by the hip, shoulder, wrist, ankle, and elbow. There is usually no limiting basement plate under the well-vascularized synovial membrane, facilitating the Inhibitors,research,lifescience,medical entry of hematogenously carried bacteria into the joint space [9]. Septic arthritis of the SCJ is extremely rare, comprising 0.5–1% of all joint infections Megestrol Acetate [10], but results in abscess formation in 20% of cases [11,12]. The SCJ is the only joint connecting the trunk with the pectoral girdle, and is therefore involved in all major movements of the upper limb. The function of the articular disc on the clavicular side of the SCJ is to resist the compressive load [13]. SCJ infection can cause life-threatening complications, because the joint capsule is unable to distend and infection spreads beyond the joint quickly, leading to fistula formation, cutaneous abscess or, rarely, mediastinitis and superior vena cava syndrome [14,15]. The pathogenesis of SCJ infection is not well understood, but it appears to result from either hematogenous or contiguous spread.