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Updated: May 15, 2025

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Infectious Costochondritis With Sternal Osteomyelitis.

Koichi Fujiu1, Kazuhide Uesugi2, Yoshiyuki Maruya3

  • 1General Thoracic Surgery, Southern TOHOKU General Hospital, Koriyama, JPN.

Cureus
|April 7, 2025
PubMed
Summary

This case study highlights a successful treatment for infectious costochondritis and sternal osteomyelitis caused by Pseudomonas aeruginosa. Surgical debridement combined with targeted antibiotics proved effective in resolving the infection and preventing recurrence.

Keywords:
costochondritisosteomyelitis treatmentpseudomonas aeruginosa pathogenesisradical debridementsternum

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Area of Science:

  • Infectious diseases
  • Orthopedic surgery
  • Medical imaging

Background:

  • Costochondritis is typically inflammatory and treated with NSAIDs, but infectious forms can arise from direct infection.
  • Infectious costochondritis with sternal osteomyelitis is rare and challenging to treat, often requiring aggressive management.

Observation:

  • A 59-year-old male with diabetes presented with persistent chest pain and swelling, later diagnosed with Pseudomonas aeruginosa infection.
  • Imaging revealed sternal osteomyelitis and costochondritis, with purulent exudate and a fistula, despite negative blood cultures.
  • The infection did not appear to spread from adjacent tissues, suggesting a distinct infectious pathway.

Findings:

  • Diagnosis of infectious costochondritis and sternal osteomyelitis was confirmed.
  • Treatment involved a combination of antibiotics (meropenem, cefepime, levofloxacin) and surgical debridement of affected cartilage and sternum.
  • The extent of debridement was guided by MRI, intraoperative palpation, and bone bleeding.

Implications:

  • Surgical debridement is crucial for treating severe infectious costochondritis with sternal osteomyelitis.
  • Accurate perioperative assessment of debridement extent is vital for successful outcomes.
  • This case demonstrates effective management of a rare and complex infection with a multi-modal approach.