Salmonella infections in patients with systemic lupus erythematosus: a case series

Abstract

Background: Systemic lupus erythematosis (SLE) patients are highly susceptible to infections.

Aim: We aim to present our experience regarding the manifestations and outcomes of Salmonella infections in a group of Filipino SLE patients.

Methods: This study reviewed the medical records of Filipino SLE patients with documented Salmonella infection seen at the Rheumatology Clinics of the University of Santo Tomas (UST) Hospital, Manila, Philippines from 2002 to 2009.

Results: Included were 12 patients (11 female), with mean age of 25.75 years (range 11-53 years) and average SLE disease duration 4.45 years to Salmonella infection. Five had septic arthritis (knee in 4, hip in 1), one of whom had concomitant typhoid fever. Another two patients had typhoid fever only. Sepsis syndrome was noted in three. One patient each had soft tissue abscess and meningitis. Salmonella typhi was isolated in seven patients, Salmonella sp. in four, and S. enteritidis in one patient. Two patients developed acute respiratory distress syndrome (ARDS), another had mixed Salmonella and Klebsiella pneumonia. Eleven patients were on high-dose steroids for active disease, including one patient with antecedent first infusion of cyclophosphamide plus rituximab. Management consisted of antimicrobials and adjunct surgery for arthritis and abscess. Except for three patients with Salmonella sepsis, all other patients improved with appropriate therapy.