Bilateral Femoral Osteomyelitis with Knee Arthritis due to Salmonella enteritidis in a Patient with Systemic Lupus Erythematosus

Abstract

A bilateral knee septic arthritis due to Salmonella enteritidis developed in a female patient affected by long-standing systemic lupus erythematosus (SLE) with cardiac and renal involvement treated with immunosuppressants and corticosteroids. Because avascular necrosis and multiple osteomyelitic areas were detected at the same time in both right and left femoral condyles, an early localisation of Salmonella into the bone was assumed. Involvement of the joints was regarded as consequence of local dissemination of infection. Ampicilline (0.2 g/kg body weight daily for 2 months) plus ciprofloxacin (1.5 g daily for 12 months) and withdrawal of immunosuppressants appeared to be effective in preventing complications of infection.

A case of retroperitoneal abscess caused by Salmonella Oranienburg

“…Even though bacterial excretion is prolonged by antibiotics, effective antibiotics are considered necessary in infants in the first 3 months of life, those ill with AIDS or malignancy, children with hemolytic anemias, and any child who appears toxic enough to have bacteremia suspected. 2 Some cases of extraintestinal focal infection of Salmonella have been reported, including osteomyelitis, 3,4 suppurative arthritis, 5,6 splenic or pancreatic abscess, 7,8 meningitis or brain abscess, 9,10 and myocarditis. 11,12 Although a case of mycotic femoral artery aneurysm caused by SOR has been reported, 15 there have been no published cases of SOR-induced abscess formation such as that of our patient.…”

Bone infarcts: Unsuspected gray areas?

“…Malignant transformation should be considered if a previously asymptomatic site of bone infarct starts to cause inflammatory pain or shows radiological changes. There have been a handful of cases of bacterial infection at sites of bone infarct [27][28][29], a complication shared with femoral head AVN. Imaging studies show typical pre-existing bone infarction, ruling out septic necrosis complicating osteomyelitis.…”

Clinical problem‐solving: ‘persistent knee arthritis and prolonged fever in a lupus patient’

“…There is a high prevalence of osteoarticular involvement (30%) in salmonellosis cases among lupus patients. 2,[9][10][11][12][13] The infection has a tendency to become generalized, and bacteremia can persist for longer periods among these patients. Moreover, salmonella infections in these patients have a high (29%) recurrence rate.…”