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Question
Posted by: casamer | 2007/05/29

Q.

Painful enlarged clavicle

8 weeks ago I woke up with a huge red swelling above my LEFT eyebrow.
Over the next 2 weeks, severe swelling appeared on my left side, over my eyelid, then down over my cheek, then further downwards to my jaw.
I finally saw the Doc. He said it was a spider bite, which I'm allergic to. (I have Asthma & a lot of allergies, mainly drugs - anaphylactic reaction 5 times).
He prescribed Erythromycin (I'm allergic to penicillin) & Prednisone.

I took first doses at around 9pm, after dinner.

I woke up around 3am with searing pain in my RIGHT clavicle, sternum side.

This has lasted for 6 weeks & getting worse. My right side clavicle looks like it is disclocated, with the bone obviously enlarged & protruding outwards. Very painful, limiting movement of my shoulder, neck & arm on right side. (No injury that I can recall .... at 3am??? Also no bruising at all).

Doctors & my physio are perplexed ....

Can a spider bite (KZN south coast), treated with an antibiotic & cortisone, cause a very painful clavicle bone condition just hours after starting treatment?


Expert's Reply

A.

Expert ImageCyberDoc

Dear Casamer
My first thought was that they should exclude gout, arthritis and then septic ( bacterial infection) arthritis. Have they done some blood tests? Apparently X/ray does not show much but CT or MR scan may be diagnostic.

Sternoclavicular joint septic arthritis manifesting as a neck abscess: a case report - Original Article
Ear, Nose & Throat Journal, August, 2003 by Atta Mohyuddin
The sternoclavicular joint is commonly involved in ankylosing spondylitis, degenerative arthritic conditions (i.e., rheumatoid arthritis and osteoarthritis), and primary and secondary metastatic conditions. Yood and Goldenberg reported that this joint was also involved in as many as 9% of cases of septic arthritis. (3) The differential diagnosis of a swollen sternoclavicular joint includes rheumatoid arthritis, osteoarthritis, Tietze's syndrome, rheumatic fever, gout, and tumors. (1) Risk factors for sternoclavicular joint infection include diabetes mellitus, rheumatoid arthritis, alcohol abuse, hemodialysis, trauma, and subclavian venipuncture. (4,5)

The onset of sternoclavicular joint infection is insidious, and the duration of clinical symptoms ranges from a few days to 2 months. (2) Pain on movement is present in the ipsilateral shoulder. Akkasilpa et al found that all 21 patients they studied exhibited fever and pain on shoulder movement during the course of their illness. (6) Fever is usually of low grade, and chills are absent. Our patient experienced shoulder pain, but no fever. An elevated erythrocyte sedimentation rate and a normal leukocyte count are usual, as was the case with our patient.

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user comments
Posted by: casamer | 2007/05/29

Thanks, Doc, for the reply.

I totally agree with what you are saying.
I have been "suspected" of having rheumatoid arthritis, SLE and anything & everything else in the past ... even Porphyria. (This all runs in my family).

However, the problem seems to be in the bone itself - not in the joints.

Today I saw my friend, who is a Physio, but she is also the BEST diagnostic medical person on KZN South Coast.
She first thought "joint" .... then, after further examination, she said that it's actually the clavical bone itself. It's large, painful and out of proportion.

This whole thing transpired within 6 hours of taking the drugs prescribed by the doctor.

An allergy, perhaps?

I will be seeing my doctor again on Thursday (earliest I can get).
In the meantime, I am in much pain .... any suggestions for temporary relief?

casamer

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