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Chest Swelling and Fever in an Intravenous Drug User

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Author(s): Grijalva, Ray A | Ritter, Michael | Langdorf, Mark I.

Journal: Western Journal of Emergency Medicine
ISSN 1936-900X

Volume: 9;
Issue: 2;
Start page: 112;
Date: 2008;
Original page

Keywords: sternoclavicular abscess | pseudomonas | intravenous drug use

ABSTRACT
This case report describes a sternoclavicular infection in an IV drug user. The history and physical exam suggested an abscess. In the emergency department (ED) the patient refused incision and drainage but did consent to simple needle aspiration. Subsequent culture of the aspirate revealed Pseudomonas aeruginosa. He was admitted for IV antibiotics. After admission, a bone scan suggested the presence of osteomyelitis. The patient refused operative d├ębridement, but ultimately did consent to bedside incision and drainage. By day five, the fever had resolved and the patient signed out AMA. He was given a prescription for Ciprofloxacin. The patient had an unscheduled follow up in the ED five months later for an unrelated heroin overdose. Physical examination demonstrated complete resolution of the infection.
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