case_images: PMC11116605_01
case_images: Erythematous swelling at the right sternoclavicular joint.
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case_images: One month after the last ICI injection, she developed pain and swelling in her right SCJ accompanied by fever, resulting in restricted range of arm and neck motion ( Figure 1 ).
case_images: The imaging findings of the right sternoclavicular joint without evidence of bone fractures, abscesses, osteonecrosis, or metastasis (white arrows). (A) Computed tomography image shows increased fatty tissue concentration. (B) Magnetic resonance imaging with short tau inversion recovery reveals hyperintensities. (C)
  18F-Fluorodeoxyglucose-positron emission tomography image demonstrates abnormal uptake (SUVmax = 4.1).
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case_images: C-reactive protein (CRP) level of 10.74 mg/dL (normal: < 0.3 mg/dL). Computed tomography (CT) revealed an increased fatty tissue concentration, and magnetic resonance imaging (MRI) showed hyperintensities of short tau inversion recovery (STIR) surrounding the SCJ ( Figures 2A, B ). The subsequent (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed increased uptake at the right SCJ (SUVmax = 4.1) ( Figure 2C ).
case_images: Clinical course. Although the combination of glucocorticoid and antibiotic therapy improved the serum CRP level, the patient's NRS score remained at 7/10, indicating persistent inflammation. After twice intravenous infliximab induction, NRS score as well as serum CRP level completely resolved. GC: glucocorticoid, mPSL: methylprednisolone, PSL: prednisolone, ABPC/SBT: ampicillin/sulbactam, GRNX: garenoxacin, IFX: infliximab, NRS: numerical rating scale.
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case_images: f3
case_images: CRP levels completely resolved, and her NRS score was 0 ( Figure 3 ). Consequently, the patient withdrew from NSAIDs and opioid analgesics.