Brucella Infection of the Sternoclavicular Joint with Innovative Localized Drug Delivery: A Case Report and Review of...

Brucellosis is typically associated with complications involving the osteoarticular, cardiovascular, and central nervous systems. However, septic arthritis of the sternoclavicular joint (SCJ) represents an isolated and exceptionally rare clinical entity. We report a case of Brucella-induced SCJ abscess successfully managed via the localized implantation of doxycycline-loaded calcium sulfate. This targeted drug delivery system offers a robust therapeutic strategy for controlling focal infections in atypical anatomical locations.

A 47-year-old woman presented with intermittent fever and a progressively enlarging clavicular mass. Physical examination revealed distinct, tender swelling over the right SCJ. The patient's symptoms were refractory to prior antimicrobial therapy with cefuroxime sodium. Computed tomography (CT) demonstrated localized soft tissue swelling and osteolytic destruction at the SCJ. Magnetic resonance imaging (MRI) further characterized the pathology, revealing cortical erosion, marrow edema, and abscess formation. Serological testing confirmed the diagnosis by demonstrating a Brucella antibody titer of 1:400. The patient underwent surgical intervention. Intraoperative exploration exposed significant yellowish-white purulent exudate covering the joint surface. Following extensive debridement, doxycycline-loaded calcium sulfate beads were implanted into the residual cavity, and a drainage catheter was placed. Postoperatively, she received intravenous cephalosporins for two weeks, followed by oral doxycycline and rifampin. At the three-month follow-up, inflammatory markers-including ESR, CRP, and IL-6-had normalized. Long-term monitoring confirmed complete recovery without recurrence.

Managing infections at atypical sites often necessitates the adaptation of standard therapeutic protocols. This case illustrates that novel modalities, specifically localized antibiotic delivery systems using calcium sulfate, can effectively treat complex infections where systemic therapy alone may be insufficient. By ensuring sustained local antibiotic release, this strategy expands the therapeutic armamentarium available for clinicians addressing rare, site-specific presentations of pathogens such as Brucella.