An Unusual Presentation of Salmonella: Cellulitis, Gastroenteritis, and Bacteremia

BACKGROUND Salmonella enterica commonly causes self-limited gastroenteritis but can occasionally lead to invasive disease in predisposed hosts. Soft-tissue involvement is an uncommon complication, and the combination of bacteremia, cellulitis, and gastroenteritis has rarely been described. Cellulitis without abscess formation appears to be exceptionally rare. CASE REPORT A 75-year-old man with diabetes, peripheral arterial disease, and cirrhosis presented with right lower-extremity cellulitis following several days of non-bloody diarrhea. On examination, he was afebrile and hemodynamically stable, with edema extending from the foot to the mid-shin and an ulcer on the posterolateral calf. Imaging showed diffuse subcutaneous edema without abscess. Blood cultures, wound cultures, and stool polymerase chain reaction (PCR) were positive for Salmonella enterica (pan-sensitive), confirming bacteremia, soft-tissue infection, and gastroenteritis. Cellulitis resolved with a 7-day course of intravenous ceftriaxone. Transthoracic echocardiography demonstrated no evidence of endocarditis, and repeat blood cultures obtained on hospital day 2 were negative. There was no recurrence at the 3-week and 3-month follow-ups. CONCLUSIONS Very few cases of Salmonella enterica infection with this triad of manifestations have been reported. The absence of abscess formation further distinguishes this presentation. Underlying vascular disease and skin disruption may have created a susceptible environment for infection through hematogenous seeding or direct inoculation. This case shows the importance of considering Salmonella species in atypical soft-tissue infections, particularly in patients with chronic vascular or metabolic disease and concurrent diarrheal illness, and emphasizes the need for early microbiologic diagnosis and targeted antimicrobial therapy to ensure a favorable outcome.