ABSTRACT

A 21-year-old male presented with pain in the right thigh of insidious onset and 3 months' duration. He had a history of febrile illness lasting for 15 days, 2 months prior to the onset of pain. Examination revealed swelling over the lower lateral aspect of the right thigh with some induration and tenderness. Initial X-rays of the right femur and the computed tomography scan at 10 weeks after the onset of disease were normal. Magnetic resonance imaging scan showed signal alteration with minimal destruction of the anterior cortex in the mid-diaphyseal region of the right femur. A repeated X-ray taken at 15 weeks after the onset of illness showed erosive changes, along with periosteal reaction in the diaphyseal area. The Widal test was positive. Open biopsy of the lesion revealed inflammatory non-caseating tissue. Culture of the specimen grew Salmonella typhi. The patient was given antibiotic treatment. Both X-rays and the Widal titres were normal on subsequent follow-up at 3 months.

Key words: osteomyelitis; salmonella osteomyelitis; typhoid osteomyelitis

INTRODUCTION

Salmonella osteomyelitis is a rare entity, constituting 0.8% of all salmonella infections and only 0.45% of all types of osteomyelitis.1 The 3 most common strains of salmonella causing osteomyelitis are Salmonella typhimurium, Salmonella typhi, and Salmonella enteritidis, with Salmonella typhi being the only strain to be transmitted from human to human. Osteomyelitis caused by Salmonella panama has also been reported in the literature.2 Salmonella infections may present in 5 different clinical forms namely, gastroenteritis, enteric fever, bactaeremia (without localised infection), focal disease (including soft tissue infection), and the chronic carrier state.3 There is a striking association between salmonella osteomyelitis and sickle cell anaemia. Typhoid osteomyelitis has a predilection for patients with diabetes, systemic lupus erythematosus, lymphoma, liver disease, previous surgery or trauma, those at extremes of age, and patients using steroids.1,4 The incidence of typhoid osteomyelitis in otherwise healthy individuals is much lower. There are very few cases reported in the literature in which salmonella osteomyelitis is seen in an otherwise healthy individual.2,5,6

CASE REPORT