Septic Arthritis by Salmonella in immunocompetent Pediatric Patient: Case Presentation
Angel Buitrago, L.F.; Melendez, K.; Velez, F.; Alicea, I.
Boletin de la Asociacion Medica de Puerto Rico 109(1): 69-72
2017
ISSN/ISBN: 0004-4849 Document Number: 703071
Septic arthritis is a medical emergency because it is correlated with a high risk of joint damage if treatment is delayed. Although septic arthritis due to Salmonella has been described in immunocompromised patients, such as Systemic Lupus Erythematous and Sickle Cell Disease, it is very rare in immunocompetent patients. From our research only 8 pediatric cases were reported on the literature on the last 10 years. We report a case of a previously healthy 2 year old that was admitted with the diagnoses of gastroenteritis and persistent fever that started to develop limping of the left side. Stool culture, urine and blood culture where negative. After progression of the symptoms bilateral hip MRI was performed, revealing effusion of the left hip that was suggestive of septic arthritis. Orthopedic service was consulted and synovial fluid culture was collected from which salmonella ssp grew. Patient was treated with Cefepime for 28 days by recommendations of infectology with marked clinical improvement, as well as, inflammatory markers such as C-Reactive Protein (CRP), and Erythrocyte Sedimentation Rate (ESR). It is important to consider salmonella septic arthritis in the differential diagnosis of a limping patient, especially after gastrointestinal symptoms due to its high potency of hematogenous spread.
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