Tuberculosis of the sternoclavicular joint - Report of two cases

The sternoclavicular joint accounts for only 1 to 2% of all cases of periph eral tuberculous arthritis and is more often infected by pyogenic organisms than by the tubercle bacillus, We report two cases of sternoclavicular joi nt tuberculosis, in a 38-year-old man and a 46-year-old woman without risk factors for immune deficiency. Swelling of the joint was the presenting man ifestation, Laboratory tests indicated inflammation in only one of the pati ents. The intradermal tuberculin test was strongly positive in both patient s, whereas smears and cultures of sputum and urine samples were negative fo r the tubercle bacillus, Serologic tests for the human immunodeficiency vir us were negative, Erosions of the affected joint were seen by computed tomo graphy, Histological studies of a surgical biopsy specimen confirmed the di agnosis, Cultures of the biopsy specimens were negative. The outcome was fa vorable after treatment with rifampin, isoniazid and pyrazinamide for six m onths in the man and nine in the woman. follow-ups were eight and six month s, respectively, at the time of this writing. Tuberculosis of the sternocla vicular joint is extraordinarily rare and can raise diagnostic problems. Th e diagnosis should be considered in every patient with arthritis in a stern oclavicular joint or unexplained pain in a shoulder. Possible complications include compression or erosion of the large blood vessels at the base of t he neck and migration of tuberculous abscesses to the mediastinum.