A case of osteomyelitis caused by Salmonella enterica: Key aspects of diagnostic imaging

Abstract

Case presentation. A 46-year-old man with a history of Hodgkin's lymphoma, treated fifteen years earlier, in complete remission. In March 2024, the patient presented with fever, abdominal pain, and diarrhea, leading to a diagnosis of intestinal infection by Salmonella enterica, which resolved after antibiotic treatment. Two months later, he consulted for progressive pain in his right elbow, without fever or history of trauma. Physical examination revealed pain on palpation of the proximal ulna, without swelling or erythema. The initial X-ray was normal; ultrasound showed cortical irregularity, and magnetic resonance imaging revealed medullary edema and cortical erosion, findings consistent with osteomyelitis. Treatment. An image-guided percutaneous bone biopsy was performed, confirming osteomyelitis and isolating Salmonella enterica serotype Typhi sensitive to ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. Sequential treatment was initiated with intravenous ceftriaxone for two weeks, followed by intravenous ciprofloxacin for two weeks, and finally, oral trimethoprim-sulfamethoxazole for four weeks, for a total of eight weeks of treatment. Outcome. The patient progressed favorably, with disappearance of pain and functional recovery of the affected limb. Surgery was not necessary, and at the end of follow-up, he was asymptomatic, with no clinical recurrence.