Salmonella sepsis in a patient with TLR4 gene polymorphisms

Abstract

Non-typhoid Salmonella gastroenteritis is one of the most common forms of intestinal infections among the population of developed countries and generalized forms of infection are rare. We present a case of 67-year-old woman with salmonaella sepsis, deep venous thrombosis, and septic thromboembolism of pulmonary artery complicated with development of necrotizing pneumonia. Generalization of the infectious process was mediated by the presence of polymorphisms in the TLR4 gene. Development of pulmonary infarction is infrequent. Even rarer is a formation of cavities in infarcted lung tissue, usually in the background of the infectious disease. A combination of 2 rare conditions in 1 patient demonstrates the need of multidisciplinary approach in treatment of severe and atypical forms of infectious diseases to evaluate the primary etiology of such state. The article will discuss various aspects of lung tissue damage caused by Salmonella and give a brief overview of the literature on this topic.

Keywords: Necrotizing pneumonia; Non-typhoid Salmonella; Pulmonary embolism; Salmonellosis, Sepsis.

Fig. 1

CT angiography at the admission. At the level of bifurcation of the right pulmonary artery, a saddle-shaped thrombus (1) is determined, spreading into the branches of the upper lobe (2). The pulmonary trunk (3) is slightly expanded (diameter is 32 mm), the right and left branches of the pulmonary artery are not expanded (diameters are 24 and 21 mm, respectively). Aortic walls are calcified (4)

Fig. 2

Chest CT at the admission, axial slices. In S1 of the right lung there is a cavity with irregular walls up to 5-mm thick and smooth outer margins and with liquefied content (1). In S1-S2 of the right lung, there are triangular-shaped subsegmental in homogeneous zones of increased attenuation (2). Linear subsegmental atelectasis (3) is visualized in S3 of the right lung. The walls of the segmental bronchi of the right lung are thickened (4).

Fig. 3

Follow-up chest CT on the 7th day of hospitalization. The level of the axial slices corresponds to the slices in Fig. 2. There is a decrease in the volume of the cavity (1) in S1 of the right lung and the disappearance of the liquid level in it. The formation of multiple cavities is noted in structure of consolidations in the S1-S2 of the right lung (2). The interlobar pleura is thickened (3). The walls of segmental and sub-segmental bronchi are thickened (4). Subsegmental linear atelectasis in S3 of the right lung remains unchanged (5).

Fig. 4

Chest CT 3 months after discharge. In the S1 of the right lung there are fibrous cords replaced the cavities.