Sir,
I read with great interest the article by Kumar and Babu [1], entitled “Refractory Tietze’s Syndrome Occurring after Lumbar Spine Surgery in Prone Position.” The association between Tietze syndrome and malposition has not been known, and this case report will add an insight into the pathophysiology of this disorder. I have recently experienced a case of Tietze syndrome, which may be due to a habitual prone position.
A 24-year Japanese woman with no medical history visited our hospital because of persistent precordial pain. Her symptom developed soon after she woke up 7 days ago. She said that she usually lay on her face when she slept. The pain worsened, especially when she leaned forward. She worked in sales and did not recall having an injury. On examination, the third left costochondral joint was swelling and palpation of the joint caused pain. There was no rash on her trunk and limbs. Ultrasonography revealed the bulky costal cartilage near the third left costochondral joint (Fig. 1). The findings on chest radiography and electrocardiography were unremarkable. She began taking loxoprofen, and her precordial pain disappeared the following day. The swelling resolved within 20 days after the onset.
Fig. 1.
The bulky costal cartilage near the third left costochondral joint
Tietze syndrome is a rare but benign inflammation of the costal cartilage [2]. In most patients, a single site is affected, most commonly the second or third costochondral joint. Pain is generally intensified by cough, sneezing, and chest movements [3]. Although the characteristic of Tietze syndrome has been described recently, the underlying mechanism has not been well known. Further reports should be accumulated to decide whether malposition is associated with this disorder.
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References
- 1.Kumar VA, Babu JN. Refractory Tietze'’ syndrome occurring after lumbar spine surgery in prone position. Indian Journal of Orthopaedics. 2019;53:574–577. doi: 10.4103/ortho.IJOrtho_276_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sawada K, Ihoriya H, Yamada T, et al. A patient presenting painful chest wall swelling: Tietze syndrome. World Journal of Emergency Medicine. 2019;10:122–124. doi: 10.5847/wjem.j.1920-8642.2019.02.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze's syndrome. British Journal of Rheumatology. 1997;36:547–550. doi: 10.1093/rheumatology/36.5.547. [DOI] [PubMed] [Google Scholar]