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[Bacterial coxitis caused by Salmonella enteritidis. Case report and differential diagnostic considerations]
M R Sarkar1, C Rose, N Wachter
1Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Universität Ulm. michael.sakar@medizin.uni-ulm.de
Abstract:
Secondary haematogenous joint involvement is seen in less than 1% of patients with Salmonella infections. These atypical infections are frequently encouraged by pre-existing local or systemic disease. We present a case of a patient with known alcohol abuse who developed a septic infection of her right hip requiring resection of the femoral head. Histologic analysis showed signs of pre-existing osteonecrosis probably induced by alcohol intake. Cartilage and bone were invaded and destructed by an aggressive granulation tissue. Initially, a biopsy evaluated without knowledge of the positive bacteriological result had been interpreted as indicative of a tumour. The onset, clinical course, diagnosis and therapy of joint involvement by Salmonella are discussed with regard to our case and the relevant literature. This case illustrates the necessity for clinicians to share all their information about the patient with the pathologist.
Insights
Salmonella septic arthritis, though rare, can occur in patients with underlying conditions like alcohol abuse. This case highlights the importance of sharing clinical information with pathologists to ensure accurate diagnosis and treatment of such infections.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pathology
Background:
- Secondary hematogenous joint involvement is a rare complication of Salmonella infections, occurring in less than 1% of cases.
- Pre-existing local or systemic diseases often predispose patients to these atypical infections.
- Alcohol abuse is identified as a potential contributing factor to underlying bone and joint pathology.
Observation:
- A case of a patient with a history of alcohol abuse who developed a septic infection of the right hip is presented.
- The infection led to the destruction of cartilage and bone by aggressive granulation tissue, necessitating femoral head resection.
- Initial biopsy findings were misinterpreted as a tumor due to a lack of complete clinical information.
Findings:
- Histologic analysis revealed pre-existing osteonecrosis, likely alcohol-induced, in the affected hip joint.
- Salmonella infection aggressively invaded and destroyed joint tissues, including cartilage and bone.
- Accurate diagnosis was achieved by integrating bacteriological results with clinical and histological data.
Implications:
- This case underscores the critical need for comprehensive communication between clinicians and pathologists in diagnosing rare infectious joint diseases.
- Early and accurate diagnosis of Salmonella septic arthritis is crucial for appropriate management and preventing severe joint destruction.
- Understanding the role of pre-existing conditions like alcohol-induced osteonecrosis is vital for managing Salmonella-related joint infections.