Subacute Bifocal Salmonella Osteomyelitis of the Mid Shaft of Femur and Ipsilateral Proximal Tibia in a Healthy Female: A Case Report.

INTRODUCTION

Osteomyelitis in adults is most commonly associated with Staphylococcus aureus or epidermidis. Healthy bone is inherently resistant to infection, until seeding of a source of infection occurs either by hematogenous spread or by direct inoculation. Salmonella spp. has been accountable for 0.45% of all osteomyelitis regardless of the age. Due to a culmination of factors, the infection is rarely seen in an immunocompetent young adult. Here, we report a case of Salmonella osteomyelitis in a young female.

CASE REPORT

A 24-year-old otherwise healthy female patient presented with acute-onset pain of right mid shaft of femur and proximal tibia. She had a normal radiograph with raised inflammatory parameters. She had a hypointense lesion in the T1-weighted imaging, features suggestive of osteomyelitis. A second lesion hyperintense lesion on T2-weighted magnetic resonance imaging (MRI) was seen in the proximal tibia with a fracture line in the anteromedial cortex of proximal tibia of the right leg, possibly osteomyelitis. The patient was taken up for open biopsy, sampling for culture and debridement. The culture grew Salmonella spp. The patient was treated with 6 weeks on intravenous ertapenem and 2 weeks of oral cotrimoxazole. She was completely symptom free by 6 weeks and repeat MRI at 6 months showed healed status of the index site.

CONCLUSION

Adult-onset acute bifocal Salmonella osteomyelitis is extremely rare. Early diagnosis and prompt debridement with tailored antibiotics help in preventing the spread of the disease and is curative.