title: [Septic arthritis of hip due to Salmonella Typhi in a patient with multiple sclerosis].
abstract: The most common microorganisms isolated from septic arthritis are Staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. are rare and the most commonly isolated species are S.Choleraesuis and S.Typhimurium. However the number of septic arthritis cases due to S.Typhi is low in literature. In this report, septic arthritis of hip due to S.Typhi in a multiple sclerosis patient who was under steroid therapy, was presented. A 25-year-old female patient was admitted to our clinic with the complaints of fever, left hip pain, standing and walking disability for 10 days. Her anamnesis revealed that she had had a multiple sclerosis attack and underwent triple pulse steroid therapy. Laboratory findings were as follows; WBC count: 16.300/mm3 (70% polymorphonuclear leukocyte), hemoglobin: 10.6 g/dl, erythrocyte sedimentation rate: 140 mm/hour, CRP: 28.7 g/L, AST: 86 U/L and ALT: 77 U/L. In lumbosacral magnetic resonance imaging, trochanteric bursitis and generalized myositis were detected in left hip joint compatible with septic arthritis. S.Typhi was isolated from patient's blood and operational tissue samples. Serum Salmonella TO and TH titers were found as 1/400 and 1/200, respectively. Antibiotic susceptibility test was performed by disk diffusion method, and the isolate was found susceptible to ampicillin, chloramphenicol, ceftriaxone, ciprofloxacin and trimethoprim-sulphametoxazole. The patient was treated by surgery and also by two weeks parenteral (2 x 400 mg) and 6 weeks oral (2 x 500 mg) ciprofloxacin treatment. Six months follow-up of the patient revealed that clinical, radiological and laboratory findings were normal. As far as the national literature was considered, this was the first S.Typhi septic arthritis case involving the hip joint and demonstrating bacterial growth both in blood and operational tissue. The presentation of the infection as arthritis plus diffuse myositis and bursitis, is also noteworthy.
authors.affiliation: Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey. aliolut@yahoo.com
authors.forename: Ali Ilgın
authors.initials: AI
authors.lastname: Olut
authors.forename: Meltem
authors.initials: M
authors.lastname: Avcı
authors.forename: Onur
authors.initials: O
authors.lastname: Ozgenç
authors.forename: Taşkın
authors.initials: T
authors.lastname: Altay
authors.forename: Seher Ayten
authors.initials: SA
authors.lastname: Coşkuner
authors.forename: Sibel
authors.initials: S
authors.lastname: Ozsu Caymaz
authors.forename: Ayla
authors.initials: A
authors.lastname: Havuk
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D016470:Bacteremia / Q000382:microbiology; D002062:Bursitis / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008826:Microbial Sensitivity Tests; D009103:Multiple Sclerosis / Q000150:complications* / Q000188:drug therapy; D009220:Myositis / Q000382:microbiology; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification*; D013256:Steroids / Q000008:administration & dosage; D014435:Typhoid Fever / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery
chemical_list: D000890:Anti-Infective Agents; D013256:Steroids; D002939:Ciprofloxacin