Non-typhoidal Salmonella infection usually causes self-limiting gastroenteritis, but a minority of cases are complicated by bacteraemia and extraintestinal focal infection. Vertebral discitis and osteomyelitis are rare complications, most often described in patients with diabetes, haemoglobinopathy, or immunosuppression. We describe a 67-year-old man with hypertension and previous percutaneous coronary intervention who attended the emergency department five times over six weeks with fever, rigors, diarrhoea, and worsening thoracic back pain after travel to Sri Lanka and the Maldives. Blood cultures grew Salmonella Java susceptible to ceftriaxone, ciprofloxacin, and co-trimoxazole. Initial CT of the chest, abdomen, and pelvis was unremarkable. CT angiography performed several weeks later showed mid-thoracic vertebral destruction and disc space change. MRI confirmed severe T6-T7 discitis and osteomyelitis with prevertebral soft tissue involvement of the adjacent oesophagus and azygous vein, together with periaortic enhancement from T5/T6 to T9. CT angiography found no aortitis. A repeat echocardiogram showed no evidence of infective endocarditis. Treatment required several antimicrobial adjustments, including prolonged intravenous ceftriaxone and later oral step-down to amoxicillin. Back pain improved substantially and serial radiographs showed no vertebral collapse. This case illustrates that Salmonella Java can seed the spine without classical immunocompromising risk factors and that the diagnosis is often delayed when persistent back pain is initially attributed to travel-associated gastroenteritis. Recurrent or unresolved symptoms after a confirmed Salmonella bacteraemia warrant early spinal MRI.
Abdelgabar et al. (Tue,) studied this question.