Abstract
A 47-year-old man who was diabetic and undergoing hemodialysis, had his left leg amputated because of necrosis and MRSA infection of the foot. He received intravenous vancomycin hydrochloride (VCM) therapy. We found tumorous swelling of the right sternoclavicular joint 14 days after the operation, and performed local drainage immediately and detected MRSA in the discharge. We continued intravenous VCM therapy, but failed to prevent dislocation of the joint. Then joint resection and continuous irrigation were performed, but serous fluid containing MRSA collected in the dead space after the drainage tube was removed. We tried local infusion therapy of VCM under guidance of ultra-sound image. The concentration of VCM was 25 mg/ml, and 2 ml of the solution was infused 5 times at 7-day intervals. The inflammation subsided, and no recurrence was observed for 5 years.
Infection of the sternoclavicular joint is uncommon. Some authors recommend resection of the joint with ipsilateral pectoralis major muscle flap when the expansion of the inflammation is not minimal. Our experience concurs with this opinion. Although, local infusion of VCM is not officially approved, and is not recommended easily, it may be the treatment of choice in some special situations.
