Simultaneous Salmonella septic arthritis and naïve tricuspid valve endocarditis: A case report

Salmonella osteoarticular involvement is a rare complication, occurring in about 2% of the cases. Septic arthritis is exceedingly rare, involving only 0.2 % of all salmonellosis patients. Endocarditis is another complication that occurs in less than 0.8 % of cases. These complications are more likely to happen among immunocompromised patients.

We report a previously healthy 25-year-old man who presented with left limb pain. He had been treated for brucellosis ten days earlier by his primary care physician. Arthrocentesis and subsequent hip-joint biopsy confirmed septic arthritis due to Salmonella. However, he was unresponsive to the treatment. We found no underlying immunosuppression. A trans-esophageal echo was performed due to the continued fever and positive blood cultures. It revealed Salmonella endocarditis of the naïve tricuspid valve. He was treated via arthrotomy and antimicrobials for four weeks. Follow-up after 20 months showed no underlying immunosuppression.

This case highlights that in patients with positive Salmonella blood cultures and a focus of infection compatible with Salmonellosis but unresponsive to treatment, searching for other foci of infection is necessary. Furthermore, physicians in endemic areas of brucellosis should consider other differential diagnoses in patients with fever and limping because any delay in diagnosing Salmonella septic arthritis can destroy the joint space with lifelong discomfort.