Salmonella typhimurium-endocarditis secondary to an acquired environmental infection: a case report

A diabetic, cardiopathic and anemic 44-year-old farmer presented with a seven-day history of remittent fever with evening peaks. Two months before he had undergone amputation of the V-finger of the left hand secondary to a phlegmon caused by an agricultural injury. Prior to amputation, anaerobic culture analysis of phlegmon-pus and selective procedures used to isolate Gram-positive cocci and/or Pseudomonas spp. resulted negative. The diagnosis of endocarditis was supported by isolation of S. typhimurium from blood and by echocardiography showing endocarditic lesions. The source of infection was identified by PCR ribotyping as the same Salmonella typhimurium strain that was present, but not sought, both in the anatomic explanted tissues and from blood samples of the patient. The infection was successfully treated with a combination of gentamicin and ampicillin with consequent improvement in the general clinical picture of the patient. We believe this is the first reported case of S. typhimurium-endocarditis secondary to a phlegmon resulting from an environmental source of infection.