Costocondritis y espondilitis diferidas por Candida en paciente post-COVID tratado previamente con corticoides, antibióticos y tocilizumab / Delayed Candida costochondritis and spondylitis in a post-COVID patient previously treated with corticosteroids, antibiotics, and tocilizumab

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Primary infectious costochondritis due to Prevotella nigrescens in an immunocompetent patient: clinical and imaging findings.

Infection of costal cartilage is a rare observation. We report the case of a 43-year-old male patient without relevant history who presented with a progressive painful swelling of the left chest wall since 4 months. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess within the left ninth costal cartilage with surrounding reactive changes. A CT-guided biopsy was performed and the culture of the sample revealed the presence of Prevotella nigrescens. Musculoskeletal infections by Prevotella are rarely described in the literature, Prevotella oralis and Prevotella bivia being the most frequently observed pathogens. These infections usually originate from a hematogenous spread after thoracic surgery or dental procedure. In our patient, conservative treatment was chosen. A clinical improvement was noted after 1-month antibiotherapy, confirmed by short-term and 6-month imaging follow-up showing the complete disappearance of all previously observed abnormalities.

Diagnostic value of fluorine-18 deoxyglucose positron emission tomography/computed tomography in deep sternal wound infection.

OBJECTIVES: Deep sternal wound infection (DSWI) is a refractory complication after heart surgery, and debridement is the first-line treatment. The accurate identification of the extent of the infection is the key to successful debridement. The present study assessed the diagnostic accuracy of fluorine-18 deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for identifying the infected area of DSWI. METHODS: Between February 2015 and May 2017, 73 consecutive patients with suspected DSWI received 18F-FDG PET/CT examinations before their operation. The PET/CT and extracted CT images were analyzed by nuclear medicine physicians and radiologists to determine whether the sternum, mediastinum, vascular prosthesis, and each costal cartilage were infected. All the patients received debridement and chest wall reconstruction within 1 week following the PET scan. The final diagnosis was on the basis of surgical, microbiological, and histopathological findings. RESULTS: Of the 73 patients, 64, 54, 28, and 6 patients were diagnosed with sternal osteomyelitis, mediastinitis, costal chondritis, and vascular graft infection (VGI), respectively. The sensitivities of PET/CT for diagnosing sternal osteomyelitis, mediastinitis, and costal chondritis were 98.4%, 77.8%, and 100.0%, respectively, and the corresponding specificities were 94.7%, 82.1%, and 100.0%, respectively. PET/CT correctly diagnosed all six cases of VGI. There were 65 infected costal cartilages in the patients with costal chondritis. The sensitivity, specificity, and accuracy of PET/CT for locating infected costal cartilages were 81.5%, 99.8%, and 98.6%, respectively. CONCLUSIONS: PET/CT proved to be a useful tool for determining the depth of DSWI and for locating infected costal cartilage; therefore, this tool can help guide debridement.

Primary chest wall abscess caused by Escherichia coli costochondritis.

Chest wall abscess may occur as primary infection or secondary to open trauma or thoracic wall surgery. The authors describe an unusual case of Escherichia coli costochondritis occurring 2 months after a blunt chest wall trauma. Primary chest wall abscess due to E coli costochondritis has been previously reported only twice occurring after urinary tract infection. All other very few reports of E coli costochondritis have been reported only after thoracic surgical procedures. An English literature review of primary chest wall abscess showed that 4 pathogens are responsible for the majority of cases: Actinomyces, Staphylococcus aureus, Candida albicans and Salmonella. C albicans costochondritis was most commonly reported among heroin addicts. The appearance of a growing chest wall mass should always prompt a search for an infectious cause, even with little or no systemic signs and symptoms.

Meticillin-sensitive Staphylococcus aureus costochondritis in a healthy man.

BACKGROUND: A 54-year-old previously healthy white man presented to hospital with fever, right parasternal pain and swelling over the right second and third costochondral joints. The symptoms had developed 1 week earlier. INVESTIGATIONS: Physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, blood and urine culture, plain radiography and CT of the chest, (99m)Tc bone scintigraphy, ultrasound-guided needle aspiration of soft tissue mass, Gram staining and culture of aspirated fluid. DIAGNOSIS: Meticillin-sensitive Staphylococcus aureus costochondritis. MANAGEMENT: CT revealed a 2 x 5 cm soft tissue mass at the posterior aspect of the right second and third costochondral joints. The fluid aspirated contained Gram-positive cocci, and culture revealed the presence of meticillin-sensitive S. aureus. The patient received a 6-week course of flucloxacillin (2 g by intravenous injection every 6 h for 2 weeks, then 1 g orally every 6 h for 4 weeks). He responded well to treatment, and was discharged from hospital.

Bone scintigraphy and costochondritis.

Four patients with infectious costochondritis were studied with computed tomography (CT) and bone scintigraphy. In all four patients the bone scan detected and accurately localized the sites of involvement. CT did not image bilateral involvement in one patient. Three of the four patients were intravenous drug abusers; in two of these patients, a species of Aspergillus was the offending organism. Therefore, in patients with signs and symptoms of chest wall inflammation, scintigraphy is the most direct route to the diagnosis of costochondritis. This entity is apparently occurring more frequently because of the prevalence of intravenous drug abuse. Bone scintigraphy delineates both the extent of individual costochondral lesions and their multiplicity.

Costal chondritis in heroin addicts: a comparative study with postsurgical chondritis.

Infection of the chondrocostal junction occurs infrequently nowadays. However, with the increasing incidence in the last years of intravenous drug addiction, more cases have been reported recently. The authors studied two groups of patients with costal chondritis, one of heroin addicts and the other of patients who had undergone thoracic surgery previously. While in the postsurgical group the patients need some kind of resection for their treatment, in the heroin addicts an early drainage is usually enough.