Salmonella septic and aseptic arthritis in sickle-cell disease. A case report.

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.