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Salmonella septic and aseptic arthritis in sickle-cell disease. A case report
R C Henderson1, B D Rosenstein
1Division of Orthopaedic Surgery, University of North Carolina, Chapel Hill 27599.
Abstract:
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.
Insights
A young man with sickle-cell disease experienced Salmonella septic arthritis and aseptic arthritis. This case highlights challenges in treating uncommon infections and managing complex arthritis in sickle-cell patients.
Area of Science:
- Orthopedics
- Infectious Diseases
- Hematology
Background:
- Sickle-cell disease (SCD) patients are susceptible to infections, including septic arthritis.
- Salmonella infections are common in SCD patients but antibiotic resistance is increasing.
- Acute arthritis in SCD presents complex diagnostic and therapeutic challenges.
Observation:
- A 26-year-old male with SCD developed septic arthritis in one knee due to Salmonella and aseptic arthritis in the contralateral knee.
- The Salmonella infection exhibited rare resistance to trimethoprim-sulfamethoxazole, delaying optimal antibiotic treatment.
- The patient's aseptic arthritis could be attributed to SCD-related synovial ischemia or reactive arthritis from a remote Salmonella infection.
Findings:
- This case presents an uncommon Salmonella septic arthritis in a patient with sickle-cell disease.
- The study discusses two potential pathophysiologic mechanisms for acute aseptic arthritis in SCD: synovial ischemia and reactive arthritis.
- No prior orthopedic literature has discussed these specific mechanisms in the context of SCD and Salmonella infection.
Implications:
- This case underscores the diagnostic and therapeutic complexities of acute arthritis in sickle-cell disease patients.
- It highlights the importance of considering antibiotic resistance patterns, even rare ones, in managing Salmonella infections.
- The findings suggest a need for further research into the mechanisms of aseptic arthritis in SCD and its relationship to infections.