Suwannaroj S, Mootsikapun P, Vipulakorn K, Nanagara R
Divisions of Rheumatology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Clin Rheumatol. 2001 Apr;7(2):83-5. doi: 10.1097/00124743-200104000-00006.
Necrotizing fasciitis is an uncommon manifestation of Salmonella infection. We report a case of Salmonella group D septic arthritis complicated with necrotizing fasciitis in a 51-year-old man who had noninsulin dependent diabetes mellitus and rheumatoid arthritis. He presented with fever and severe right hip pain complicated with septic shock and disseminated intravascular coagulation. Crepitation was noticed upon physical examination, and plain films showed numerous air bubbles in the soft tissue around the hip joint. Prompt antibiotic therapy and surgical management were performed with a successful response. The causative organism was Salmonella group D. Antibiotic was given in the total course of 3 months, and there was no relapse of salmonellosis after 2 years follow up. The differential diagnosis of causes of non-clostridial crepitant soft tissue and muscle infections must include Salmonella, especially in patients who have underlying diseases or are taking immunosuppressive drugs. Prompt management is needed to reduce mortality and morbidity. Long-term suppressive therapy may be needed to prevent relapse.
坏死性筋膜炎是沙门氏菌感染的一种罕见表现。我们报告一例51岁男性，患有非胰岛素依赖型糖尿病和类风湿性关节炎，其感染D组沙门氏菌引发败血症性关节炎并伴有坏死性筋膜炎。他表现为发热和严重的右髋部疼痛，并伴有感染性休克和弥散性血管内凝血。体格检查时发现有捻发音，X线平片显示髋关节周围软组织中有大量气泡。及时进行了抗生素治疗和外科处理，治疗效果良好。致病菌为D组沙门氏菌。抗生素总共使用了3个月，随访2年未出现沙门氏菌病复发。对于非梭菌性伴有捻发音的软组织和肌肉感染病因的鉴别诊断必须包括沙门氏菌，特别是对于有基础疾病或正在服用免疫抑制药物的患者。需要及时处理以降低死亡率和发病率。可能需要长期抑制性治疗以预防复发。
