Abstract

Salmonella septic arthritis in healthy individuals is a rare phenomenon in the United States. This case report chronicles the clinical course of a 41-year-old male farmworker who presented with a 3-week history of fever, chills, night sweats with pain, and swelling and redness of his left ankle. He had an open fracture of the ankle 2 years earlier that healed and was asymptomatic despite prior radiographic evidence of avascular necrosis of the talar dome. One month before presentation, he had an ipsilateral periungual abscess of the great toe that he opened and drained himself. Joint cultures were positive for Salmonella enteritidisthat was successfully treated with a 6-week course of IV ceftriaxone.

Salmonella enteritidis is a motile, enteric, gram-negative bacillus that is rarely found as the primary pathologic organism of infection in the musculoskeletal system. ¹ Acute arthritis caused by gram-negative bacilli can occur after instrumentation, traumatic injury to the joint, or arthrocentesis. ² It can also be the causative agent in osteomyelitis septic arthritis ^3–8 or as a postinfectious reactive arthritis. Most patients with Salmonella septic arthritis have either a predisposing disease, such as sickle cell anemia ^9,10 or systemic lupus erythematosus,^11–13 or a predisposing condition, such as a prosthetic joint ^14–17 or avascular necrosis. ¹⁸There have been only two case reports of Salmonella septic arthritis in otherwise previously healthy individuals in the United States since 1984. ^3,7 This report details a patient with septic arthritis from S. enteritidis treated within the past year in the United States.