An Elusive Diagnosis Hiding in Plain Sight

Area of Science:

• Infectious Diseases
• Orthopedics
• Internal Medicine

Background:

• Persistent gluteal pain poses diagnostic challenges, especially with a history of prior infections.
• A middle-aged female patient experienced prolonged, undiagnosed left gluteal pain.
• Previous investigations failed to identify the etiology of the debilitating symptoms.

Purpose of the Study:

• To report a case of Salmonella Typhi causing chronic gluteal pain.
• To discuss the diagnostic difficulties in identifying atypical bacterial infections.
• To emphasize the importance of considering uncommon presentations of common pathogens.

Main Methods:

• Clinical case presentation and detailed patient history.
• Diagnostic workup including imaging, bone biopsy, and bone marrow aspirate.
• Microbiological culture for pathogen identification.
• Therapeutic intervention with targeted antibiotic therapy.

Main Results:

• Bone biopsy and bone marrow aspirate cultures confirmed Salmonella Typhi (S. Typhi) infection.
• The patient exhibited a marked improvement in gluteal pain and overall condition after antibiotic treatment.
• The diagnosis was established after multiple prior investigations proved inconclusive.

Conclusions:

• Salmonella Typhi can present atypically, causing chronic localized pain syndromes.
• Aggressive diagnostic approaches, including invasive sampling, are crucial for identifying rare pathogens.
• Early and appropriate antibiotic therapy is effective in managing Salmonella Typhi infections presenting with musculoskeletal symptoms.