Hospital for Special Surgery, New York, NY 10021, USA.
Lupus. 2013 Jun;22(7):740-3. doi: 10.1177/0961203313491022.
Hematogenous Salmonella osteomyelitis is uncommon in immunocompetent hosts, but occurs with some regularity in immunosuppressed patients affected by systemic lupus erythematosus (SLE). Surgical debridement with resection of compromised tissue is central to the surgical management of osteomyelitis. Persistence of septic arthropathy may result from inadequate debridement, areas of osteonecrosis (ON), and an abnormal cellular and humoral dysregulation characteristic of SLE. We describe a 53-year-old Hispanic female with SLE on immunosuppressive therapy, who developed acute salmonella-induced septic arthritis and osteomyelitis of both knees associated with ON and recurrent SLE synovitis. She received prolonged antibiotic therapy and an extensive surgical debridement as part of a successful two-stage bilateral total knee replacement. This report illustrates the significance of Salmonella enterica infection in SLE patients, and the role of underlying bone and joint pathology such as bone infarcts, sub-acute osteomyelitis, and SLE synovitis.
血源性沙门氏菌骨髓炎在免疫功能正常的宿主中并不常见，但在系统性红斑狼疮（SLE）等系统性免疫抑制患者中时有发生。骨髓炎的手术治疗以彻底清创和切除受影响的组织为中心。关节清理不彻底、骨坏死（ON）以及 SLE 特征性的细胞和体液异常调节，可能导致化脓性关节炎持续存在。我们描述了一位 53 岁的西班牙裔女性，患有 SLE 并接受免疫抑制治疗，她发生了急性沙门氏菌引起的双膝化脓性关节炎和骨髓炎，伴有 ON 和复发性 SLE 滑膜炎。她接受了长期抗生素治疗和广泛的清创手术，作为双侧全膝关节置换术成功的两阶段治疗的一部分。本报告说明了沙门氏菌感染在 SLE 患者中的重要性，以及骨和关节病理的作用，如骨梗死、亚急性骨髓炎和 SLE 滑膜炎。
