A 68-year-old man presented with about a week history of purpura on the extremities follwing fever elevation. He exhibited painful swelling of the right sternoclavicular joint. Leukocyte count was 13200 /μl and CRP was 17.02 mg/dl. ESR was 119 mm/hr. X-rays showed a lytic change in the medial end of the right clavicle and hyperostosis in the medial end of clavicle. CT revealed that the medial end of clavicle, the first rib, and a portion of the sternum were eroded. MRI and bone scintigraphy showed arthritis and osteomyelitis. Open biosy indicated Gram positive rod. He underwent a debridement with the pectoralis major muscle covering the bony defect. Operateve findings revealed lytic change of the cortical bone, and abnormal granulation in the bone marrow. When there is evidence of infection beyond a joint, such as myelitis, an aggressive surgical therapy is necessary.
