Display options
Cite
Khan TMA, Siddiqui AH, Ansari Y, et al. Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone. Cureus. 2019;11(11):e6155doi: 10.7759/cureus.6155.
Khan, T. M. A., Siddiqui, A. H., Ansari, Y., Ansari, S. A., & Siddiqui, F. (2019). Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone. Cureus, 11(11), e6155. https://doi.org/10.7759/cureus.6155
Khan, Tahir Muhammad Abdullah, et al. "Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone." Cureus vol. 11,11 (2019): e6155. doi: https://doi.org/10.7759/cureus.6155
Khan TMA, Siddiqui AH, Ansari Y, Ansari SA, Siddiqui F. Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone. Cureus. 2019 Nov 14;11(11):e6155. doi: 10.7759/cureus.6155. PMID: 31890364; PMCID: PMC6913913.
Copy Download .nbib Format: NLM
Share it on

Cureus. 2019 Nov 14;11(11):e6155. doi: 10.7759/cureus.6155.

Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone.

Cureus

Tahir Muhammad Abdullah Khan, Abdul Hasan Siddiqui, Yusra Ansari, Saad Ali Ansari, Faraz Siddiqui

Affiliations

  1. Internal Medicine, Marshfield Medical Center, Marshfield, USA.
  2. Pulmonary and Critical Care Medicine, Staten Island University Hospital / Northwell Health, Staten Island, USA.
  3. Internal Medicine, Rawalpindi Medical College, Rawalpindi, PAK.
  4. Internal Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK.
  5. Pulmonary and Critical Care Medicine, Robert Packer Hospital, Sayre, USA.

PMID: 31890364 PMCID: PMC6913913 DOI: 10.7759/cureus.6155

Abstract

Septic arthritis of sternoclavicular joint (SCJ) is a rare disease, however, not uncommon in patients who abuse intravenous drugs. It can present with a wide range of manifestations that can pose diagnostic challenges, which can result in a delay in diagnosis and treatment. Over the last few decades, there is a surge in the use of nonprescription recombinant human growth hormone (rhGH) by the young healthy population and athletes for its purported ergogenic effects. Furthermore, we lack quantitative information about the adverse effects of the chronic use of rhGH in a healthy population due to the scarcity of epidemiological data. We are reporting a case of a young male athlete who was chronically using the subcutaneous rhGH formulation to build lean body mass, and presented with septic arthritis of right SCJ due to methicillin-sensitive Staphylococcus aureus (MSSA) complicated by a necrotic inflammatory response involving the mediastinum which infiltrated the apical lung parenchyma. The clinical presentation masqueraded as the mediastinal mass raising the suspicion of mediastinal malignancy. Histological analysis of the tissue of SCJ and mediastinal area revealed no malignant cells but a lymphocyte-predominant inflammatory response with germinal centers was observed, which was an atypical response to MSSA bacterial infection. We have reviewed the literature to elucidate the immune-modulatory effect of rhGH, as the chronic use of rhGH by our patient probably has contributed to an atypical immune response to MSSA. The patient was treated with an extended duration of parenteral antibiotics and multiple incision and debridements to achieve complete resolution of infection over the next six months. This is a unique case of septic arthritis of right SCJ in a patient on chronic subcutaneous rhGH which masqueraded as a mediastinal mass raising concern of malignancy; moreover, it highlights the probable immune-modulatory role of rhGH which instigated an atypical immune response to MSSA infection.

Copyright © 2019, Khan et al.

Keywords: drug abuse; growth hormone; immune modulation; mediastinal mass; methicillin sensitive staphylococcus aureus; septic arthritis; sternoclavicular joint

Conflict of interest statement

The authors have declared that no competing interests exist.

References

  1. Br J Sports Med. 2006 Jul;40 Suppl 1:i35-9 - PubMed
  2. Medicine (Baltimore). 2004 May;83(3):139-48 - PubMed
  3. Germs. 2019 Mar 01;9(1):43-46 - PubMed
  4. Endocr Rev. 2012 Apr;33(2):155-86 - PubMed
  5. Rheumatol Int. 2017 May;37(5):819-824 - PubMed
  6. MMW Fortschr Med. 2013 Jul 25;155 Suppl 2:41-3 - PubMed
  7. Int J Immunopharmacol. 1994 Aug;16(8):667-73 - PubMed
  8. J Clin Invest. 2008 Mar;118(3):844-7 - PubMed
  9. Eur J Endocrinol. 1994 May;130(5):463-8 - PubMed
  10. Ann Intern Med. 2008 May 20;148(10):747-58 - PubMed
  11. Arch Orthop Trauma Surg. 2011 Mar;131(3):319-23 - PubMed
  12. J Biol Chem. 1976 Jun 25;251(12):3720-9 - PubMed
  13. Nutrition. 2002 Jul-Aug;18(7-8):657-61 - PubMed
  14. Immunol Cell Biol. 2017 Mar;95(3):306-315 - PubMed
  15. Blood. 1993 Aug 1;82(3):954-60 - PubMed
  16. J Clin Endocrinol Metab. 1994 Oct;79(4):984-90 - PubMed
  17. Arch Intern Med. 1977 Aug;137(8):1036-40 - PubMed

Publication Types