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Salmonella osteomyelitis: A rare differential diagnosis in osteolytic lesions around the knee
1Department of Orthopaedic Surgery, RWTH Aachen University, Germany.
Abstract:
Salmonella osteomyelitis in immunocompetent adults is uncommon. It usually has a diaphyseal location or present as spondylitis. Metaphyseal affection is extremely rare. A 51-year-old male presented with refractory knee pain. Plain X-rays showed a rounded osteolytic lesion in the proximal tibia without marginal sclerosis. A minimal C-reactive protein elevation and a normal leucocytic count were present. Further imaging raised suspicion of malignancy so that a biopsy was done. After fenestering the lesion, 15-ml turbid fluid was evacuated. Microbiological examination showed Salmonella enteritidis. Repeated debridements were done and antibiotic therapy with ciprofloxacin was initiated. The cavity was then filled with synthetic bone graft leading to progressive healing. Although rare, Salmonella bone infection usually lacks the typical periosteal reaction and the laboratory evidence of infection of pyogenic osteomyelitis. It should therefore be considered in the differential diagnosis of osteolytic neoplastic lesions.
Insights
Salmonella osteomyelitis, a rare bone infection in adults, can mimic bone cancer. Early diagnosis and treatment with antibiotics and surgery are crucial for healing.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Radiology
Background:
- Salmonella osteomyelitis is uncommon in immunocompetent adults, typically affecting the diaphysis or spine.
- Metaphyseal involvement of Salmonella osteomyelitis is exceptionally rare.
Observation:
- A 51-year-old male presented with severe knee pain and an osteolytic lesion in the proximal tibia.
- Initial imaging suggested malignancy due to the lesion's appearance and minimal inflammatory markers.
- Biopsy revealed Salmonella enteritidis, with turbid fluid evacuation.
Findings:
- The patient underwent surgical debridement and antibiotic treatment with ciprofloxacin.
- The bone cavity was filled with a synthetic bone graft, leading to progressive healing.
- Salmonella bone infections often lack typical signs of pyogenic osteomyelitis, such as periosteal reaction and elevated white blood cell counts.
Implications:
- Salmonella osteomyelitis should be considered in the differential diagnosis of osteolytic bone lesions, especially when typical infection markers are absent.
- This case highlights the importance of microbiological examination in diagnosing unusual bone infections.
- Aggressive surgical and antibiotic management can lead to successful outcomes in rare cases of Salmonella osteomyelitis.
