Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Jan-Feb;7(1):69-74.
doi: 10.13107/jocr.2250-0685.694.

Multi-foci Salmonella enteritis Osteomyelitis of Thoracic Spine with Pleural Effusion and Fatal Outcome. A Unique Case Presentation and Review of the Literature

Ioannis Papaioannou  1 , Andreas Baikousis  1 , Panagiotis Korovessis  1
Affiliations
Case Reports

Multi-foci Salmonella enteritis Osteomyelitis of Thoracic Spine with Pleural Effusion and Fatal Outcome. A Unique Case Presentation and Review of the Literature

Ioannis Papaioannou et al. J Orthop Case Rep. 2017 Jan-Feb.

Abstract

Introduction: A case of thoracic vertebral osteomyelitis due to Salmonella enteritis (SE) in an immunocompetent patient is reported. This is the third case in the literature of SE thoracic vertebral osteomyelitis, but the first one with this multi-foci presentation and finally fatal outcome due to meningoencephalitis. Further data that makes our case unique are the absence of fever (body temperature: 37.4°C) and gastrointestinal disorders.

Case report: A 57-year-old male patient initially presented with thoracic pain, dyspnea, and knee pain. Examinations revealed a large pleural effusion and septic arthritis. Blood and all these sides (vertebrae, pleural fluid, and joint fluid) cultures revealed SE. The infection was successfully treated with three surgical interventions, plus antibiotic administration. First, a chest tube was inserted and at the same time, we took cultures and specimens from the infected sites. Subsequently, bone debridement and spine fusion were performed, and finally, knee fusion was held with an Illizarov device. Although 8 months later, our patient passed away due to viral meningoencephalitis and severe hydrocephalus, due to immunosuppression after Salmonella infection recurrence. Furthermore, no sign of relapse was found in the last follow-up, just 2 months ago.

Conclusion: Physicians should be aware for this rare but potentially fatal spinal infection. Osteomyelitis of thoracic spine should be considered in the differential diagnosis of pleural effusion. More suspiciousness is needed due to the possibility of immunosuppression and relapse, even with sufficient antibiotic administration and negative inflammatory markers. Follow-up should be more frequent and accompanied with blood cultures taking.

Keywords: Immunocompetent patient; Salmonella enteritis spondylodiscitis; extra-intestinal focal infections; immunosuppression; relapse; thoracic vertebrae; titanium mesh cage.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Sagittal T2 magnetic resonance imaging from the first hospitalization, with increased signal of T12 vertebrae.
Figure 2
Figure 2
Sitting position chest X-ray with significant pleural effusion of the left side.
Figure 3
Figure 3
Lateral radiogram of thoracolumbar spine with significant deterioration and osteolytic lesions of T12.
Figure 4
Figure 4
Sagittal computed tomography scan image of T12. Diffuse presentation of T12 vertebrae, with narrow adjacent disc space.
Figure 5
Figure 5
Transverse computed tomography scan image of T12, shows the destruction of the vertebrae.
Figure 6
Figure 6
Lateral post-operative radiogram, shows the anterior (cage) and posterior instrumentation.
Figure 7
Figure 7
Sagittal computed tomography scan image of 6-month follow-up, shows the fusion and the incorporation of the mesh cage.
Figure 8
Figure 8
Anteroposterior radiogram of fused knee of 6-month follow-up. The Illizarov device has been removed, and two screws for patella fixation are shown.
Figure 9
Figure 9
Brain computed tomography scan image with drainage tube due to severe hydrocephalus.
See this image and copyright information in PMC

References

    1. Gupta SK, Pandit A, White DG, Evans PD. Salmonella osteomyelitis of the thoracic spine:An unusual presentation. Postgrad Med J. 2004;80(940):110–111. - PMC - PubMed
    1. Lakshmi K, Santhanam R. Thoracic spinal osteomyelitis due to Salmonella enteritidis in an immunocompetent mimicking tuberculosis. J Neurosci Rural Pract. 2016;7(2):317–319. - PMC - PubMed
    1. Rubin RH. Salmonellosis:Microbiologic, Pathologic, and Clinical Features. New York: Stratton Intercontinental Medical Book Corporation; 1977. pp. 46–58.
    1. Higgins GA, Sandiford JA, Blair WC. Remote salmonella infections. World J Surg. 1982;6(2):236–240. - PubMed
    1. Ortiz-Neu C, Marr JS, Cherubin CE, Neu HC. Bone and joint infections due to Salmonella . J Infect Dis. 1978;138(6):820–828. - PubMed

Publication types

LinkOut - more resources