A rare case of septic arthritis of the knee caused by Salmonella typhi with preexisting typhoid fever in a healthy, immunocompetent child - A case report

Salmonella Septic Hip Arthritis in Immunocompetent Children: Three Case Reports and Literature Review

Septic arthritis is an orthopaedic emergency, especially considering the pediatric population. Salmonella is a less common aetiologic factor for septic arthritis compared with other Gram-negative bacteria. Its isolation in immunocompetent children and infants is quite rare, with an estimated incidence of 0.1% to 0.2% of septic arthritis cases among children. We report three rare cases of hip septic arthritis with Salmonella as a confirmed pathogen in immunocompetent children, with two of them being infants. The main symptoms that occurred in all three cases were fever, hip pain/no bearing, and diarrhoea, as well as elevated levels of WBC, C-reactive protein and ESR. The duration of their hospitalization was 20, 26 and 52 days. One case was treated only with antibiotics, while the other two with surgical drainage with/without arthrotomy. All cases had a follow-up of at least one year, with only one of the infants having the femoral head in a subluxated position and early signs of osteonecrosis. Fluoroscopy-assisted closed reduction had to be performed and maintained by hip spica. A new femoral epiphysis was formed at the time of the last follow-up 2.5 years later. Our case series highlights the possibility of Salmonella typhi septic hip arthritis in immunocompetent individuals. Therefore, Salmonella species must always be kept in mind during the differential diagnosis of septic arthritis in a clinically relevant setting.

Bilateral hip septic arthritis caused by nontyphoidal Salmonella group D in a 16-year-old girl with COVID-19: A case report

Introduction and importance

Nontyphoidal Salmonella infection can lead to gastroenteritis, enteric fever, and bacteremia. However, joint infections due to this bacterium are rare, and usually associated with immunosuppressive disorders.

Case presentation

A 16-year-old girl, with a recent history of acute lymphocytic leukemia (ALL) presented with bacteremia, and bilateral hip pain after COVID-19 symptoms. Clinical presentation, laboratory features and imaging showed bilateral nontyphoidal Salmonella septic arthritis. We administered antibiotics, based on antibiotics susceptibility pattern of the isolated Salmonella.

Clinical discussion

The case is presented because reports of bilateral hip joint infection due to nontyphoidal Salmonella are rare especially after COVID-19. When the patient presents with joint discomfort, the clinician should think infection especially in immunocompromised hosts.

Conclusion

It illustrates successful management of septic arthritis requires prompt clinical diagnosis, microorganism identification, administration of appropriate systemic antibiotics and hip joint surgery.

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Nontyphoidal Salmonella is one of the most important organisms involved in septic shock and arthritis.

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Acute lymphocytic leukemia (ALL) is a type of cancer that affects white blood cells (WBC).

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COVID-19 is a contagious disease caused by severe acute respiratory syndrome coronavirus.