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Salmonella group C necrotizing fasciitis: a case report and review of the literature

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Abstract

Localized salmonella soft tissue infections have been rarely described in humans. We report a case of necrotizing fasciitis caused by Salmonella serogroup C in a patient with systemic lupus erythematosus who was successfully treated with surgical debridement and cefoperazone–sulbactam. In addition, we provide a literature review on risk factors and treatment of this uncommon disease sequelae.

Introduction

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and life-threatening infectious process primarily involving fascia and subcutaneous tissue. Most cases of NF represent a synergistic or mixed bacterial infection of aerobic and anaerobic bacteria. Group A streptococci, Staphylococcus aureus, Enterobacteriaceae and Peptostreptococcus spp. have been the most commonly identified pathogens (Wong et al., 2003). Salmonella is generally associated with a range of benign to life-threatening human infections inclusive of asymptomatic enteric carriage, gastroenteritis, enteric fever, bacteremia, and mycotic aneurysm; rarely has salmonella NF been reported (Jidpugdeebodin and Punyagupta, 2004, Leiberman et al., 1991, Sanchez et al., 1984, Simeon-Aznar et al., 1990, Sy et al., 2001). We report a case of Salmonella group C NF in a patient with systemic lupus erythematosus (SLE) who was successfully treated with cefoperazone–sulbactam in conjunction with fasciotomy and surgical debridement.

Section snippets

Case report

A 35-year-old Thai woman, diagnosed with SLE 2 months earlier, presented to our hospital with a 2-day history of high-grade fever and right leg pain. She reported a history of diarrhea that began after eating a boiled egg 1 week before admission, but had no significant animal contact, travel history, leg trauma, or recall of uncooked poultry consumption. She was taking prednisolone (60 mg/day) as treatment of SLE with persistent active nephritis (membranous glomerulonephritis type V) for 2

Discussion

Focal salmonellosis represents less than 6% of all infections due to nontyphoidal Salmonella and may involve any organ system (Cohen et al., 1987, Fernandez Guerrero et al., 1997). Local suppurative complications have been recognized in 7–10% of all cases of salmonellosis in the general population (Cohen et al., 1987, Fernandez Guerrero et al., 1997). However, in immunocompromised hosts, focal infections account for 25% of systemic salmonellosis (Fernandez Guerrero et al., 1997). The most

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