[Persistent fever in a patient with Salmonella typhimurium gonarthritis].
A 65-year-old patient with systemic lupus erythematodes (SLE) developed fever and gonarthritis whilst taking prednisone and hydrochloroquine. Salmonella typhimurium, sensitive to amoxicillin, was grown in cultures of synovial fluid, blood and urine. After high dosages of intravenous amoxicillin, blood cultures and knee punctate became negative, but fever seemingly without a clinical focus persisted. By means of a fluoro-18-deoxyglucose positron emission tomography (FDG-PET) scan, an abscess was located in the left upper leg and successfully treated. In patients with impaired cell-mediated immunity, an extra-intestinal manifestation of Salmonella should be taken into consideration particularly if there appears to be no clinical focus. This may be detected by FDG-PET.
Becker
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Afd. Inwendige Geneeskunde, VU Medisch Centrum, De Boelelaan 1117, 1081 HV Amsterdam. a.becker@vumc.nl
van Agtmael
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Comans
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D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000209:etiology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007111:Immunity, Cellular; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D012480:Salmonella Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D012486:Salmonella typhimurium / Q000302:isolation & purification*; D014055:Tomography, Emission-Computed / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D019788:Fluorodeoxyglucose F18; D000658:Amoxicillin