Non-typhoidal, Non-paratyphoidal Salmonella Species Causing Sacroiliitis and Pyomyositis in a Healthy 19-Year-Old Athlete

Abstract

Salmonella is a gram-negative bacterium, subdivided into typhoidal and non-typhoidal Salmonella. It is usually caused by eating raw or undercooked meat, poultry, eggs, or egg products. The clinical manifestations of Salmonella infection can be divided into five syndromes: enterocolitis (food poisoning), enteric (typhoid) fever, bacteremia/septicemia, focal infection, and a chronic carrier state, which is usually asymptomatic. The most common clinical presentation is diarrhea. Salmonella osteomyelitis occurs most frequently in patients with sickle-cell disease; other risk factors include other hemoglobinopathies, immunocompromised status, and chronic Salmonella carrier state. The incidence of Salmonella osteomyelitis/septic arthritis in otherwise healthy individuals is rare. The duration of symptoms can range from a few months to several years, and multifocal involvement occurs in 15% of reported cases of Salmonella osteomyelitis. The symptoms of Salmonella osteomyelitis are pain and variable swelling of the affected limb; high temperatures are rarely noted. Our patient is a 19-year-old boy with no known past medical history who presented with severe right-sided sacroiliitis with extensive surrounding osteomyelitis on both sides of the sacroiliac joint with non-typhoidal, non-paratyphoidal Salmonella bacteremia.

Case report: A case of piriformis pyomyositis and pyogenic sacroiliitis due to non-typhoidal Salmonella bacteremia in an immunocompetent healthy adult

“…Additionally, it is also an uncommon case that pyogenic enterocolitis progressed to a subsequent sacroiliitis and was treated with conservative treatment with antimicrobial therapy without requiring surgical drainage and successful without sequelae. Among several reports of pyomyositis and sacroiliitis caused by primary NTS bacteremia, most previous cases had unknown etiology ( 12 , 13 ). Notably, mild and latent NTS enteritis was considered the cause of bacteremia, and the entry portal of bacteremia was identified as the sigmoid colon ulcer, which was the most intriguing aspect of our case.…”

“…Some cases of invasive NTS infection may present with abscess formation requiring drainage ( 7 – 10 ). However, depending on the degree of local infection, symptoms may improve with antimicrobial therapy alone ( 11 , 12 ).…”

Salmonella Osteomyelitis and Septic Arthritis in Children

“…The organism reaches the human body by direct or indirect contact with many species of animals or food derived from them, their excreta, contaminated meat, milk, eggs, and water. Infected pets, turtles, and contaminated marijuana are other sources [9]. The mode of transmission is feco-oral.…”