A 63-year-old Caucasian man presented complaining of right neck pain and dysphagia following a bout of violent coughing that he experienced on the previous day. On admission, he was haemodynamically normal with mild pyrexia. Physical examination revealed cellulitis extending from the right sternoclidomastoid region to the anterior upper chest with swelling and tenderness just above the right sternoclavicular joint. The blood tests showed leukocytosis and raised inflammatory markers. A plain chest X-ray showed a right pleural effusion. These findings raised suspicion of a spontaneous rupture of the cervical oesophagus. Oral intake was omitted and a nasojejunal tube was inserted for feeding along with empirical intravenous administration of penicillin, flucloxacillin and metronidazole. A computed tomography (CT) scan showed inflammatory changes behind the right sternoclavicular joint with small pockets of air behind the upper sternum, pleural thickening at the right apex with some adjacent lung consolidation and confirmed the presence of a pleural effusion. A gastrografin swallow study showed a small irregularity of the lateral pharyngeal wall but not definitive contrast leak, and pharyngoscopy could not find any abnormality. Paracentesis of the sternoclavicular swelling was attempted under ultrasound guidance, but no micro-organisms were isolated from the aspirate. Nevertheless, because there was still a degree of uncertainty, it was decided to treat the condition with prolonged jejunal feeding and antibiotics. After 2 weeks on this regime, the inflammation resolved completely and the patient was allowed oral feeding and discharged home. However, 9 days after his discharge, the patient presented with the same symptoms. Another CT scan established the diagnosis of septic arthritis showing erosive changes within the right sternoclavicular joint. The patient restarted a 6-week course of the same antibiotic combination but without restrictions in oral intake. Eventually, the arthritis settled and on follow-up 3 and 6 months later, respectively, the patient remained asymptomatic.