Tuberculosis of the sternoclavicular joint

Abstract

Purpose. To review the diagnosis and treatment of tuberculosis of the sternoclavicular joint in 13 patients. Methods. Records of 9 men and 4 women aged 26 to 47 (mean, 36.5) years who presented with tuberculosis of the right (n=8) or left (n=5) sternoclavicular joint were reviewed. Results. All 13 patients had a raised erythrocyte sedimentation rate at presentation. Nine patients presented with systemic symptoms including malaise, fever, or loss of weight/appetite. Local symptoms included cold abscess (n=5), tenderness and non-fluctuant swelling (n=4), and discharging sinus (n=4). The mean duration of symptoms was 2.7 (range, 1–7) months. Four patients had multifocal involvement of the proximal ulna (n=1), lung (n=2), and meninges (n=1). Aspiration (n=3), fine needle aspiration cytology (n=4), drainage (n=2), or curettage (n=4) of the swelling, abscess, or sinus was performed, and the diagnosis was confirmed by histopathology (n=8), polymerase chain reaction (n=5), or culture (n=1). Two patients were diagnosed based on clinical suspicion. 11 patients responded to antituberculous therapy (ATT), and symptoms resolved after 6 to 8 weeks. Two patients did not respond to ATT after 3 months and were screened for immunocompromising disorders or drug resistance. Their CD4 count and CD4:CD8 ratio was low, and an immunomodulation regimen was prescribed as an adjunct to ATT. Conclusion. A high level of clinical suspicion is needed to diagnose tuberculosis of the sternoclavicular joint in patients with pain/tenderness, discharging sinus, or cold abscess. A combination of histopathological and microbiological tests, and PCR can confirm the diagnosis.