Unrecognized bilateral sternoclavicular joint tuberculosis treated surgically on one side and conservatively on the other side: A case report

While tuberculosis is common in developing countries, it remains an important disease in Japan. Diagnosis of sternoclavicular tuberculosis is often delayed due to its rarity, nonspecific symptoms, difficulty in X-ray diagnosis, and low culture positivity rate. A 58-year-old previously healthy man presented with right sternoclavicular joint swelling associated with slight pain. Radiological examination revealed severe destruction and abscess formation in the right joint. The left sternoclavicular joint had an asymptomatic small abscess. Preoperative laboratory data, staining, culture, and cytology showed no definitive findings of tuberculosis. Upon bursting of the abscess, diagnostic curettage was performed. Histopathological examination of the curettage specimen suggested tuberculosis. He received antitubercular therapy for 2 years. The right-sided lesion showed rapid healing while the left-sided lesion shrank gradually. Early diagnosis of tuberculosis of the sternoclavicular joint requires a high level of clinical suspicion. Surgical treatment is a better option for unrecognized chronic cases.