Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient

Abstract

Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient’s survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis.

Keywords: Bacterial infections; Immunosuppression; Renal transplantation; Osteomyelitis

Core tip: Although immunosuppression therapy improves kidney allograft and patient’s survival, it is a major risk factor for infection following kidney transplantation, altering the clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature regarding osteomyelitis in RTRs is very limited while sternoclavicular osteomyelitis is a rare entity presenting with its own unique set of risk factors and complications. Infections caused by unconventional pathogens with unconventional infection sites are being increasingly diagnosed in RTRs and the physician should always remain alert when dealing with these patients.